}

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 in-network with several insurance plans. We also accept cash, check, Visa, MasterCard and Discover for treatments in our office. Please contact us if you have any questions about coverage, insurance benefits 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 FORMS
ESTABLISHED PATIENT FORMS
NOTICE OF PRIVACY PRACTICES
PATIENT REFERRAL FORM

Accepting New Patients

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