Patient Information

We want to make your time with us as stress-free and pleasant as possible. If you have any questions or concerns, please feel free to call us at (317) 581-1280 or fill out our contact form and we will get back to you as quickly as possible.

Patient Forms

Patient forms may be completed in our office using a patient computer. If you prefer to fill out the paperwork ahead of time, please print the following forms, complete them, and bring them to your appointment.

Patient Registration

Patient Medical History

Acknowledgement of Notice of Privacy Practices

Authorization for Release of ID Health Information

Consent for Use and Disclosure of Health Information

Payment Options

Payment Options

Bridgewater Dental Care is dedicated to providing you with expert dental care. In order to deliver optimum care, we base our practice on sound business standards. Every patient will receive a detailed treatment plan with the appropriate fees and an explanation of our financial policies.

Extensive treatment will usually be divided into multiple payments due at specific points of the treatment. Our staff will be happy to discuss your payment options and schedule of payments with you, as well as assist you with insurance claims and questions.

Privacy Policy

Bridgewater Dental Care Notice of Privacy Practices