English Forms
- New Patient Questionnaire
- Medical History Form
- Consent for Use and Disclosure of Health Form
- Patient Records Release Form
- Patient Medical Consultation Request
- Office Policy Regarding Patients with Treatment Form
- Acknowledgement of Receipt Notice of Privacy Practices Form
- Financially Responsible Adult-form
- Office Financial Policy Form
Spanish Forms
Welcome New Patients
Experience The DETAIL DENTAL Way!
COME JOIN OUR IN HOUSE MEMBERSHIP PLAN!
New Patient Comprehensive Exam 100%
Two Cleanings Per Year 100%
Two Exams Per Year 100%
Fluoride Varnish 100%
Emergency Exams 100%
Radiographs 100%
Plus 20% Discount on ALL Other Procedures!
MEMBERSHIP PLAN DUES
1st Member $425.00/ year or $39.00/ month
2nd Member $325.00/ year or $29.00/ month
Each Additional Member $275.00/ year or $29.00/ month
Optional Additional Perio Plan $325.00/ year or $29.00/ month
*one time $59.00 initiation fee/ per member if paying monthly
6820 Parkdale Pl, #117 Indianapolis, IN 46234
Call for an appointment: (317) 329-7373