If you are a new patient, please print and fill out the following forms prior to arriving for your appointment. This will allow us to more promptly begin your treatment.
Adults
Adult Health History Form
Patient Contact Information
HIPAA Notice of Privacy Practices
Children (under 18)
Child Health History Form
Patient Contact Information
HIPAA Notice of Privacy Practices
These files require Adobe Acrobat Reader to view.
Download it for free.
Please bring your insurance card and photo ID with you to your appointment. We will keep your current information on file. We will happily submit the initial claim to your insurance provider. Please keep in mind that you are fully responsible for any fees not covered by your plan.
If you have questions about your payment method or Insurance provider please contact our office for more information.
We are a Participating Provider for to following:
- AETNA PPO
- Cigna PPO
- Delta Dental Premier
- Guardian Dentalguard Preferred Plan
- Guardian Dentalguard Principal Plan
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High Street is also known as State Route 23. We are north of Route 161 and south of the 270 Outer Belt. From the north side, take the 270/23 south (Worthington) exit. Travel 2 miles south and we are on the left. From the south, our office is located 3 buildings north of the Dairy Queen and one block south of the Worthington Fire Station.
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