Forms & Financial
Patient Registration Form
You may preregister with our office by completing the online Patient Registration Forms below.
Or you can download them from the links below to complete them offline. If you decide to do so, please make sure to bring them into the office on your next visit.
You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.
Financial considerations should not be an obstacle to a beautiful smile. Therefore, our practice offers a wide range of payment options. Financing with no initial payment can often be arranged. In addition, we can arrange a monthly installment plan. Many orthodontic problems require only limited treatment. The cost of treatment will vary, depending on the severity of the problem. Our treatment coordinator will work out a plan suited to your individual needs.
For your convenience, most credit cards are accepted, including Visa, MasterCard, American Express, and Discover. We deliver the finest care at the most reasonable cost to our patients. If you have questions regarding your account, please do not hesitate to contact us.
While many dental insurance plans now include orthodontic benefits for just a few dollars a month, our office will make every effort to provide you with the finest orthodontic care and the most convenient financial options. To accomplish this, we work hand in hand with you to maximize your insurance reimbursement for covered procedures.
If you have any problems or questions, please ask our staff. They are well informed and up-to-date. They can be reached by phone at the office you visit or plan to visit.
- Center City Philadelphia: 215-544-6330
- Northeast Philadelphia: 215-676-7846
- Hatboro: 215-675-0542
We would recommend having your insurance information available when you call for your initial appointment, so that we can help you in verifying your coverage. Also, please bring your insurance information with you to your initial exam so that we can expedite processing and reimbursement.