1624 Hobbs Drive, Ste 2

Delavan, WI 53115

262.740.1010

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Patient Information

New Patient Paperwork

For each new patient, please fill out, print and bring the following forms with you to your first appointment. We can also mail forms to you if you’d prefer. Please call our office to make arrangements. If you are unable to do so, please arrive 15 minutes prior to your appointment to fill out the necessary paperwork.

Privacy Practices

‍The following form is optional to print and is for your reference only.

Financing

Here at Delavan Family Dentistry, we highly appreciate the emotional and financial investment to proceed with comprehensive dentistry. During your consultation, our doctors and staff will review your treatment plan with you and provide a description of the proposed treatment. We will also discuss your investment prior to any treatment, along with several options for your convenience.

We can help you maximize your benefits. We accept most dental insurance programs used by major employers in our area. Our goal is to maximize your insurance benefits and make any remaining balance due easily affordable. We Accept: cash, checks, VISA, MasterCard and Discover.

Special financing options available with approved credit through Wells Fargo Bank, N.A. make it easy to get your treatment now and pay for it over time. Start enjoying the benefits of budget flexibility with the Wells Fargo Health Advantage credit card. Click the button below to apply! Or, you can also text “apply” to 49854 to apply through your smart phone!