New Patients - Welcome to Fay Dental Care

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Your first visit to Fay Dental Care involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You’ll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There’s also background information about our committed staff and our first visit procedures. You can also save some time by printing out and completing the patient forms in advance of your appointment.

What to Expect

Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.

New Patient Forms

Please fill out these forms so we can expedite your first visit.
  • FINANCIAL AGREEMENT - Fay Dental Care

  • I will be responsible for any financial obligations incurred in connection with dental treatment rendered at FAY DENTAL CARE. I understand that payment or patient portion must be made at the time services are rendered. I will also be subject to finance charges for unpaid balances after 30 days.

    I further understand that I am responsible for any charges incurred at FAY DENTAL CARE which are not covered by my dental insurance. Private insurance is a contract between you and your insurance company. We will not become involved in disputes between you and your insurance company regarding deductibles, co-payments, covered charges, secondary insurance, “usual and customary” charges, etc., other than to supply factual information as necessary.

    Please provide 24 hours prior notice to cancel or reschedule an appointment with FAY DENTAL CARE. We do charge an appointment fee of $43 for any missed appointments in the event 24 hour notice is not given. If siblings are scheduled same day and one family member needs to reschedule, please notify our office in advance so we may offer the appointment to another family.

  • Please print full name
  • DATE: 02/19/2019
  • This field is for validation purposes and should be left unchanged.
Adult Form
Child Form
HIPAA Form
Financial Agreement Form
  • FINANCIAL AGREEMENT - Fay Dental Care

  • I will be responsible for any financial obligations incurred in connection with dental treatment rendered at FAY DENTAL CARE. I understand that payment or patient portion must be made at the time services are rendered. I will also be subject to finance charges for unpaid balances after 30 days.

    I further understand that I am responsible for any charges incurred at FAY DENTAL CARE which are not covered by my dental insurance. Private insurance is a contract between you and your insurance company. We will not become involved in disputes between you and your insurance company regarding deductibles, co-payments, covered charges, secondary insurance, “usual and customary” charges, etc., other than to supply factual information as necessary.

    Please provide 24 hours prior notice to cancel or reschedule an appointment with FAY DENTAL CARE. We do charge an appointment fee of $43 for any missed appointments in the event 24 hour notice is not given. If siblings are scheduled same day and one family member needs to reschedule, please notify our office in advance so we may offer the appointment to another family.

  • Please print full name
  • DATE: 02/19/2019
  • This field is for validation purposes and should be left unchanged.