American Board Certified Prosthodontist

New Patients


 

To Our Dear New Patient

 

Thank you for choosing Bucks Dental Health and Esthetics, the specialist Group in

Prosthodontics, Cosmetic, Endodontics, and Implant Dentistry.  

 

Following, please find our new patient online registration forms (Registration, medical,

HIPPA, etc.), which can be filled directly online and will be received by our office

electronically once you submit it. If you have difficulty filling it online, you can also print it

out, fill and bring it to our office. 

 

You will need to fill one set of forms for each member of your family who will come to

our office. Once you submit one, use the same web form link again to fill for the next

family member.

 

NEW PATIENT FORM CLICK HERE  ea

 

Please be kindly noted that:

 

1) For us to provide you the best dental care with your comprehensive medical and

dental history in mind, and 

 

2) For us to timely and accurately process your insurance claim, 

Please make sure that you fill all the information COMPLETELY AND ACCURATELY.

Your information is secured in our medical HIPAA-compliant server.

 

3) When you come in for your first visit, State photo ID, SSN, and your dental insurance

card are needed to process your insurance reimbursement.

 

4) There are about five forms listed on the left column, which you will see. Once you

finish one, click the second form on the left column. Once you complete and sign them

all, you can then submit them.


Should you have any questions or concerns, please feel free to contact us.  We look

forward to the honor of guarding your lifelong oral health, function, and aesthetics. 

Location
Bucks Dental Health and Esthetics
108a West Butler Ave
Philadelphia Area

New Britain, PA 18901
Phone: 215-234-3780
Fax: 267-449-0644
Office Hours

Get in touch

215-234-3780