New Patients

Welcome to Poleski Family Dentistry, and thank you for choosing us to fulfill your dental needs! Prior to your first appointment, please download and fill out the forms below. This information will help our staff during examinations and treatment. It is used to help us keep accurate dental records and process any dental insurance claims.

If you are unable to fill out the paperwork beforehand, please arrive 10-15 minutes prior to your scheduled appointment time to fill it out in the office. This helps to avoid any unnecessary delays in treatment.

Patient Information

Medical History

Notification of Privacy Policy

Office Policies

Payment Information

We accept payment in the form of cash, personal checks, and some credit cards. We also accept dental insurances and will file your claims for you. For more information on accepted insurances and forms of payment, please call our office today and we will be glad to speak with you.

Poleski Family Dentistry also offers low interest payment plans via third party financing through CareCredit.