​​​Chester Family Dental​ Care​

For your convenience, you may complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment. If you are not able to complete the forms before your visit, please allow at least 15 minutes for completion in the office before you see the doctor.

We recommend that you:

Bring your insurance card.
Bring all current medications in original bottles.
Please arrive a few minutes early to fill out paperwork. At your request, we can also send you our New Patient Information Packet in advance to fill out and bring to your first appointment.
Bring a copy of any important prior records if you are transferring your care from another doctor.
Note that if a co-pay is required by your insurance company, it is due at the time of your visit and may be paid in cash, by check or with a credit card.
If you would like to take the time to complete our forms prior to your initial visit the forms are available in a printer friendly version.

• New Patient Form for Adult 18+
  
• New Patient Form for Child 0-17
  
• Financial Policy
  
• HIPAA Acknowledgement 
  
• HIPAA Notice