Please click on the links below for your new patient or health history forms. The health history form can be printed out and filled out either before your appointment or in the office. The new patient form can be completed either online or printed and completed for your first appointment. If you are taking any medications you can bring a separate listing. Patients with a history of heart ailment or joint replacement should check with their physician about pre-medications.
Records Release Request
* Required to authorize transfer of x-rays to our location
Accepted Insurance and Payment Methods
We believe that finances should not keep you from maintaining a healthy smile, that's why the Chippewa Center for Dental Excellence is in-network for several providers, including Delta Dental Premier, Delta Dental PPO, United Healthcare and Cigna. We’re always happy to review your coverage and work with you on your treatment plans.
In addition to insurance, we also accept Cash and Credit Card payment. We also offer flexible financing options through Care Credit.
Unsure if we accept your insurance or payment method? Give us a call at 715-723-7175
Access Your Patient Portal
This provides on-demand access to:
- Appointment and Treatment History
- Make payments online and view past financial information
- View your appointment history
- View your treatment history