New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (66 KB)

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (229 KB)

HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (295 KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

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Coraopolis Office

7409 University Blvd
Moon Township, PA 15108
Map & Directions
 
Phone: (412) 375-7541
 

Office Hours*:
Monday10:00am-7:00pm
Tuesday10:00am-7:00pm
Wednesday10:00am-7:00pm
Thursday10:00am-7:00pm
Friday10:00am-7:00pm
Saturday10:00am-4:00pm
SundayFor Emergencies Only

Wexford Office

9930 Grubbs Rd Suite LL40
Wexford, PA 15090
Map & Directions
 
Phone: (412) 364-6523
 

Call for appointment

Greentree Office

100 Chatham Park Dr, Suite 101
Pittsburgh, PA 15220
Map & Directions
 
Phone: (412) 344-8080
 

Office Hours*:
Monday10:00am-7:00pm
TuesdayClosed
Wednesday10:00am-7:00pm
ThursdayClosed
Friday10:00am-7:00pm
Saturday10:00am-4:00pm
SundayFor Emergencies Only

Moon Plaza Office

5990 University Blvd, Suite 28
Coraopolis, PA 15108
Map & Directions
 
Phone: (412) 264-4609
 

Office Hours*:
Monday10:00am-7:00pm
Tuesday10:00am-7:00pm
Wednesday10:00am-7:00pm
Thursday10:00am-7:00pm
Friday10:00am-7:00pm
Saturday10:00am-4:00pm
SundayFor Emergencies Only