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
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.