Online Forms (Recommended)
Peace Dental New Patient Forms

PDF Forms
Please print and bring the following to your first visit:

• New Patient Questionnaire
• Consent for Services and Financial Policy

We accept the following insurance:

• United Concordia – PPO
• UPMC – Dental Advantage

Please let us know if you have any questions about your insurance coverage. Our office staff is always available to help you with insurance claims and paperwork. We’ll work with your insurance provider to make sure that your coverage meets your needs and your budget. Our practice accepts most major credit cards and will help you process your insurance claims.

Peace Dental Membership Plan (PDMP) helps families without insurance get the proper dental care they need. For an affordable annual fee, each member of your family will receive the preventive dental care they need, and discounts on additional procedures.

Visit the Peace Dental Membership Plan page for more information.

Current HIPAA Notice (PDF)

This is for your review only. Feel free to download the PDF or ask for copy when you are in the office.

Affordable Payment Plans
Your smile is yours forever, and we want to make it as easy as possible for you to receive the best dental care when you need it. The cost of your treatment will vary depending on your individual needs and treatment plan. We will discuss with you the cost of your treatment and each of your available payment options before you begin so that you can make the best choice for you.

Financing Options
CareCredit

iCreditWorks (scan the QR code below to use the app)

Credit Cards accepted: Visa, Mastercard, Discover, and American Express