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Our Practice
About Us
Meet Our Team
Testimonials
Careers
Dental Services
Dentures/Partials
Sedation Dentistry
Dental Implants
Patient Info
What to Expect
Pain Relief Tips
Payment Options
Insurance & Payment Plans
Contact Us
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Patient Name
*
Patient Birth Date
*
Date Format: MM slash DD slash YYYY
Contact Information
Type of Primary Phone
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Primary Phone Number
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Email
*
Preferred Appointment Date & Time
Appointment Urgency
I would like to be seen ASAP
Date
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Time of Day
:
HH
MM
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PM
Location
*
Greentree
Cranberry
Greensburg
Jennerstown
Dental Priorities
Emergency Care
I need prompt emergency care
Dental Priorities
*
Indicate the reason for your dental appointment
Dental Insurance Company
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Enter 'none' if you have no insurance. We accept most, but not all insurance plans. We do not accept Avesis, Gateway, UPMC For You Dental Coverage or HMO dental insurance plans.
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Insurance Subscriber Name
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