New Patient Forms
The first visit to our office is designed to get you better acquainted with all we offer at Fairport Family Dental. We encourage questions and do our best to always deliver quality care.
Prior to your scheduled appointment:
- click on "Complete Forms Online" below to fill out and submit your medical/dental history form along with the HIPAA (patient privacy) form.
- Please note that the information you will submit will be encrypted for your protection and goes directly to our office. We appreciate the time that you will spend providing the information helping us prepare for your visit
Bring to your first appointment:
- Medical and Dental Insurance Card
- Photo ID
Our office is committed to helping patients maximize their dental insurance. Insurance policies vary, we can only estimate your coverage in good faith but cannot guarantee coverage due to the complexities of insurance contracts. We ask that you carefully read your insurance policy to be sure you are fully aware of any restrictions that apply to the benefits provided. Your estimated patient portion must be paid at the time of service. As a service to our patients, we will bill insurance companies for services and allow them 45 days to render payment. After 60 days, you are responsible for the entire balance, paid-in-full. If you have any questions, our courteous staff is always available to answer them.
Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.
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