all smiles dental - new patient forms


All of our patient forms are available in PDF format for download. Please print and fill out the necessary forms below and bring them with you to your first appointment. 

All Smiles Dental New Patient Forms upated July 2018 (pdf)



NO DENTAL INSURANCE? We are now offering an in office affordable dental savings plan.

All Smiles Dental recognizes the challenges that you, the consumer, face when it comes to paying for the cost of dental care.  At All Smiles Dental, for the cost of the membership fee, you will benefit from access to quality dental services at a substantially affordable reduced costs.




New Patients


Your First Visit

Thank you for choosing All Smiles Dental. For your convenience please print and complete the above forms for your first visit. 

Day of Your Appointment 

Please arrive 15 minutes before your scheduled appointment. This will allow us to finish any paperwork and stay on schedule with your appointment. 

Please bring the following items with you to your first appointment:

  • Dental Insurance Card (If applicable)
  • Identification such as Driver's license, military ID or state ID
  • New Patient Forms (download and complete)

If you still have any questions about your visit, please call our office. We're here to help.

Frequently Asked Questions


Everyone has questions about the dentist. Whether you are a new patient wanting to know more about your upcoming visit, or someone who has questions about general oral health, we've got you covered. If you don't see an answer to any questions you have, please don't hesitate to call us. We're happy to help.

Financing & Insurance



All Smiles Dental accepts most dental insurance plans.  

Insurance Processing

After your appointment, we will submit your claim to your insurance company. If you have a deductible or a co-pay due for services provided, those fees are due at the time of service. We provide you with a complete estimate before any treatment is performed, and we make every effort to maximize your dental benefits. However, each employer designs their own dental plan. To completely understand what is covered by your dental benefit plan, it is best to contact your employer or insurance company. Please contact your insurance provider to verify coverage and acceptance.

Cash Payments

For services not covered or not submitted to insurance, we accept cash, check or major credit cards. We do ask for payment at the time of service.


Have you been putting off needed dental work because you can't afford it? All Smiles Dental accepts CareCredit, which offers you the flexibility of monthly payments. CareCredit offers no interest for 6, 12, 18 or 24 month* periods based on your qualifications and current promotional offerings. Please read and understand the CareCredit terms and financing options.

*CareCredit promotional financing options may expire at any time. All Smiles Dental is not affiliated with CareCredit.

Visit for more information.

Your Care Team


All Smiles Dental is a family dental office in Medina (general dental office in Medina.) As your care team, the dentists, hygienists and dental assistants at All Smiles Dental pledge to provide a great experience and exceed your expectations of what it means to visit the dentist. We know that everyone has a unique smile, and unique dental health needs. You can expect your family dentist and care team to be honest and open about your treatment plan, and to act with your health in mind.