Online Forms

Click the button below to complete our digital new patient forms. No printing required.

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New Patient Form

Click the buttons below to download a PDF copy of our forms.

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Cancellation Policy

If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours notice. This courtesy, on your part, will make it possible to give your appointment to another patient.

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Insurance

We also participate with many insurance plans. Please call our office for more details.

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Payment Options

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Covid-19 Safety Protocol

To our current and future patients,

As of June 1st, our office has reopened. COVID-19 will likely be a global reality for the next one to two years. The way this virus is transmitted, combined with the very nature of a dental visit, creates unique challenges. To meet these challenges, we have re-structured our patient experience completely. Fortunately, our office could not be more ideally designed and situated to ensure limited contact during your visit:

• Stand-alone building.
• Private parking.
• Direct access from outside.
• More operatories than practitioners – allowing for ample time for exchange of air.

Appropriate protected barriers are located throughout the office. Upon arrival, each patient will call from the parking lot. They will be invited into the office for screening and temperature evaluation. After satisfactory completion of screening, patients will immediately go to the operatory for your visit. Insurance and financial concerns will be addressed during the screening. When your visit is completed, you will exit out of a second entrance. The entrance and exit on opposite sides of the building ensures a uni-directional flow of traffic through our office.

Personal Protective Equipment

• All staff will always wear masks.
• Face shields will be worn during all facets of dental work.
• All working surfaces will be disinfected in between each patient.
• The dentist and hygienists will alternate operatories between patients to ensure adequate disinfection of surfaces and ventilation of the air.

Our new protocols are a work in progress. Dutch Neck Dental will continue to make the appropriate changes to safeguard our patients as new and pertinent Covid-19 facts are brought to light.

– Dr. Ira Goldstine