Patient Information

Save Time In Our Office

The following forms can be downloaded to your computer and printed at home. By filling out these forms ahead of time you will save significant time at the time of your visit. If you have any questions when filling out these forms, please do the best you can, our staff will assist you with your questions on the day of your visit.

Please do not mail the completed forms to the office.
Please bring them with you at the time of your scheduled visit.

Patient Registration Form
Health History Form

Requires a free Adobe Acrobat Reader

Payment Options

Credit Cards

We accept the following credit cards:


	-	VISA
	-	MasterCard
	-	American Express
	-	Discover

Financing

The office also accepts the option of payment through Dental Fee Plan -- a financing program for elective medical procedures. Patients may be pre-approved for Dental Fee Plan Financing with a low-interest monthly payment plan.

Click here to apply online and for more information about Dental Fee Plan.

Dental Credit Card

Cohen & Schwartz Dental offers you the opportunity to pay your dental bills with CareCredit, a healthcare financing plan that assists our patients in paying for their treatment over time, without any up-front payment required. It's ideal for co-payments, deductibles, and treatment not covered by insurance. With CareCredit, you can take care of the bill without another thought and focus on what's most important - scheduling your appointment right away

Using CareCredit for your healthcare expenses leaves your major credit cards available for other important purchases and unexpected expenses. CareCredit has interest free plans available with flexible payment terms. And if you're looking for a way to stretch your payments out over a longer time period, they have low interest plans that give you a longer time to pay.

Click here for an application and for more information about CareCredit.