Patient Information

Thank you for choosing our office for all your dental needs. We have created a comfortable environment where you can feel confident in the level of dental care you receive.

New Patient Forms

Please download and fill out the forms below and bring them with you to your first visit.

Patient Registration

Financial Policy

Privacy Notice

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Insurance Information

Fields Family Dentistry strives to provide you with affordable, high-quality treatment that fits your budget! Your treatment plan will include a breakdown of all applicable fees, estimated insurance payments and your estimated out of pocket costs before treatment is administered.

We strongly believe in our work, professional efforts, and ethical obligations. This responsibility means that we take the best professional care, skill, and judgment in planning and delivering your dental treatments. Your payment will reimburse us for our services.

We will gladly accept assignment of any insurance, even if we are not participating providers with your plan. We will file your insurance claim for you and you will be responsible for the balance that insurance will not pay.

If we are a Participating Provider with your insurance plan, you will only be required to pay for your deductibles and estimated copays at time of service. We will then file the claim to your insurance. Any remaining balance after the claim has cleared will be billed to you.

We are Participating Providers with the following insurance companies:

  • United Concordia
  • Delta Dental Premier
  • BlueCross Dental
  • Cigna Radius

Payment Options

Payment is due at time of service unless other arrangements have been made in advance. This includes any and all deductibles and copays. We extend discounts to patients who pay in full at the start of treatment. For your convenience, we accept cash, money order, personal and bank checks, debit cards, Visa, MasterCard, and Discover. We also accept CareCredit- interest free healthcare financing.

Affordable CareCredit® Financing Options

Apply Now for CareCreditDon’t let finances stand in your way of achieving the beautiful, healthy smile you deserve! We are pleased to offer third-party financing options through CareCredit®!

A proud partner of Sychrony Bank and accepted at over 150,000 locations, CareCredit is a personal line of credit for qualifying healthcare expenses that can make your medical, dental, orthodontic, ophthalmological – even veterinary – treatments more affordable! An excellent choice for financing out-of-pocket healthcare expenses, CareCredit offers payment plans with 0% interest for up to 24 months on approved procedures, and payment plans with a low 14.90% APR for up to 60 months. If you’d like to know what your monthly payments may be under a CareCredit plan, visit their helpful Online Payment Calculator.

This flexible payment option allows you to pay for your treatment over a period of time so you can focus on what matters most – keeping your smile healthy!

No Insurance?

No problem! We offer 15-25% discount plan for patients without insurance. We also offer the following dental discount plans:

  • Fields Family Dental Plan
  • Fields Family Dental Plan for Seniors
  • Fields Family Dental Plan for Military/First Responders

What to Expect at Your First Visit

During your first visit, our objective is to get to know you better, to become familiar with your past dental experiences and to establish a treatment plan that will best meet your current needs and desires.

Also, please assist us by providing the following information:

  • Any current X-rays taken at your previous dental office.
  • If you have dental insurance, please bring your insurance card.

Comprehensive Exam

Your initial exam will last approximately one hour. Your doctor will perform a thorough exam, including an oral cancer screening. Generally, X-rays will be taken, allowing your doctor to examine your mouth for teeth decay, periodontal problems, jaw problems and any signs of oral cancer. These diagnostic records will help your doctor provide an evaluation outlining any existing dental problems and proposed treatment. We encourage you to ask questions. We’ll be glad to discuss any concerns you may have.

We do not typically clean your teeth at the initial visit but a diagnosis will be made as to the type of cleaning that would best meet your needs. You will then be reappointed with one of our wonderful hygienists for a thorough cleaning. If further treatment is required, we will also reappoint you with the doctor. Sometimes, these appointments can be combined on the same day if requested by you.

Dental Emergencies

We always have a doctor on call for any dental emergency. If you are experiencing a dental emergency after hours, please call our regular office number at (717) 697-3400. There will be instructions on the voicemail system as to how you can reach the doctor on call.

Open Communication

We believe that good dental care begins with open communication. We promise to speak candidly with you about our diagnosis and recommendations, any alternative treatments, and any symptoms present that may require treatment from a specialist. Working together, we can achieve a true partnership, with one common goal – keeping your smile beautiful and your teeth, gums and jaw joints healthy!