Patient information

Fill the forms in at home and skip the clipboard.

Before your first dental visit, we will need some information about you. It helps the team give you the best possible service. You are welcome to fill out forms in the office before your visit. If you would rather save time, read the forms over, complete them where necessary and bring them to your first appointment. That removes the paperwork from the visit itself.

Ask the front desk for printed copies, or request them by phone or email and the office will get them to you.

Call 765-471-6025Email for the forms

Six forms, by name

  1. New Patient Registration Form

    Your contact and insurance details for a first visit.

  2. New Patient Medical History

    Your health history, for new patients.

  3. Medical History Update for Current Patients

    For current patients, to bring your history up to date.

  4. Insurance Estimate

    Your estimated insurance benefits, reviewed with you before treatment.

  5. HIPAA Form

    The HIPAA privacy form.

  6. Financial Policy

    The practice's financial policy.

Paying for care

Cost and insurance benefits are reviewed before treatment.

Dr. Cronkhite and his team talk through your diagnosis and what the treatment will cost, and go over your estimated insurance benefits, before moving forward.

In-network preferred provider for

  • Delta Dental
  • Cigna
  • MetLife
  • Anthem

Using an in-network provider may save you 20% to 50% on your final dental bill. Patients with other insurance get the same level of care.

Online payments

The practice offers an online payment option, labeled Pay Now on its patient page, so a balance can be settled without a trip to the front desk. Call the office if you want it walked through.

Dental financing

Mill Creek Family Dental is partnered with Care Credit, a healthcare financing company with a variety of payment options. Ask the front desk how CareCredit could fit your family's care.

Patient education

Know what is being done, and why.

The team likes its patients well informed about their dental health and treatment. These are the nine topics they can walk you through at your visit.

  • Regular Dental Visits
  • How to Floss
  • Plaque and Tartar Control
  • Sippy Cup Tips
  • Periodontal Disease
  • Diabetes & Periodontal Disease
  • Root Canal Treatment
  • Crowns & Bridges
  • Implants

For longer reading, the practice journal has articles written for the practice's own patients.

An empty treatment room with a grey patient chair beside a frosted window

Questions about any of this

Call, and the front desk will sort out the paperwork with you.

Monday to Thursday 8:00 AM to 5:00 PM, Friday 8:00 AM to 1:00 PM. We look forward to serving you.

765-471-6025
Call the front deskRequest an appointment