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Patient Forms and Payment Information

For your convenience, we have provided online access to our patient registration forms. Please print and bring the completed forms with you to your appointment.
Dental treatment is not only an investment in your oral health but an excellent investment in your medical and psychological health. At Indiana Family Dentistry, we understand that each patient has different needs and abilities to fulfill their financial obligation. Let us help find a way to get that healthy and bright smile that you always wanted. We don’t want financial consideration to be an obstacle to addressing this important aspect of your health.
Payment Options
We accept all major credit cards, as well as cash or checks. We also work with CareCredit, the nation’s leading patient payment program to help you and your family get the smile you’ve always wanted.
Dental Insurance
We accept most dental insurance and are happy to bill your insurance company for you as a courtesy. We do our best to estimate any out-of-pocket expenses that you might incur with your individual insurance plan and are happy to answer all of your questions regarding coverage, working with your carrier to verify benefits. Payment for any procedures not covered or those that fall outside the limit your employer has set up will ultimately be your responsibility. We will work with you to set up a payment schedule that fits your budget through our convenient payment plan administered by CareCredit.
Monthly Payment Options
CareCredit is the nation’s leading patient payment program that enables you to finance 100% of your dental care or finance the amount that falls outside of your dental insurance. NO money down, NO interest, NO upfront costs, NO annual fees, and NO pre-payment penalties. CareCredit can be used by the entire family for ongoing treatment without having to reapply each visit. There is a comprehensive range of payment plans available for procedure fees from $1 to over $25,000. It only takes a few minutes to apply for CareCredit.
Pay your bill online through our secure site. Click below and use the Office Code TLNYHT