Easy Forms for Your Convenience
Before your visit, please print out the forms below, fill them out and either bring them to your appointment or fax them to us at 610-265-3560.
If you have any questions, please don’t hesitate to contact us or call our office at 610-265-3311.
![dental patient filling out forms](/assets/images/PatientForms2.jpg)
Forms
Allendale Dental Patient Forms
Please fill out the forms below before your next appointment
Policies
Appointment Cancellation Policy
To cancel an appointment, we do require 48 hours in advance notice. To cancel your appointment, please call 610-265-3311.
Emergency After Hours Care
If you have a dental emergency, and have called our office after hours, leave a message along with your phone number and make sure that your caller ID block is disabled so that Dr. Goyal is able to return your phone call.
Payment Policy
- Payment is due at the time of service. Any balance that is past 30 days will have a 1% finance charge applied to it.
- If you have insurance, our office will be happy to let you know what your estimated balance for the day is. Any amount unpaid by the insurance is your responsibility.
- We send out your insurance claim forms as a courtesy to you. The insurance company has a contract with you, and you are solely responsible for all the charges.
- Accepted payment methods include cash, credit card, debit card, and check.
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