}

MON: 9AM-4PM
TUE: 9AM-3PM
WED: 8AM-4:30PM
THU: 12PM-5PM
FRI: 8AM-1PM

Forms & Insurance

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Payment and Insurance Information

We accept most insurances and are proud to be in network with Delta Dental, United Healthcare, Cigna DPPO, Dental Network of America, SunLife and Careington. We also accept cash, check, Visa, MasterCard and Discover for treatments in our office. Please call our office if you have any questions about coverage or payment options.

Patient Forms

We offer online fillable patient forms for your convenience. Whether your child is a new or current patient to our office, we want to ensure that your visit is as efficient as possible. Download our patient forms below and fill them out online. After you have filled out the forms, please save them and submit them to info@clintonvillepediatricdentistry.com.

NEW PATIENT INFORMATION & HEALTH HISTORY FORMS
NOTICE OF PRIVACY PRACTICES
ACKNOWLEDGEMENT OF PRIVACY PRACTICES
OFFICE POLICIES
PATIENT REFERRAL FORM

Accepting New Patients

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AFFILIATIONS