Gentle Dental of Newark, NJ http://www.getsmile.net Our goal is to offer the highest standard of dental care to our patients. Our team is comprised of multi-specialists in the field of dentistry: general dentist, periodontics, endodontics and orthodontics. We work with patients individually, to give each one the undivided attention and special care they deserve. 
At Gentle Dental of NJ we offer a variety of aesthetic and restorative dental services to improve your appearance, confidence, comfort and general health. We are dedicated to providing you with excellent, personalized care to make your visit as comfortable and pleasant as possible. 
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PERSONAL INFORMATION



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INSURANCE INFORMATION

EMERGENCY CONTACT

  • I understand that I am responsible to pay Gentle Dental for any treatment performed in this o ce, in case my insurance should neglect payment.
    I understand that I am responsible for any outstanding balance. I will also take responsibility for any balances due to any collection agency. If any prosthodontics ( Bridges, crowns, dentures) are not able to be completed due to patients missed appointments, the patient will be held responsible.
    A fee of $50 will be charged to the patient’s account if cancellation notice is not given 24 hours prior to the appointment.
    I authorize Gentle Dental to submit dental claims to my Dental Insurance company in order to get pay for my dental treatment.

MEDICAL HISTORY



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Verification

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