Advanced Dental Logo
BRONX
Phone: (718) 292-8988
237 Willis Ave, Bronx, NY 10454
WESTCHESTER/SCARSDALE
Phone: (914) 874-5757

130 Garth Road, Scarsdale, NY 10583
MANHATTAN (ORTHO & PEDIATRIC)
Phone: (212) 427-2237

231 E 106th St, New York, NY 10029

FORMS AND INSTRUCTIONS


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FOR OFFICE USE ONLY:ORTHO FORMS

- Welcome Advanced Dental Orthodontic
- Informed Consent for the Orthodontic Patient - Advanced Dental
- Payment-Arrangement (BRACES) -Advanced-Dental
- Healthplex Orthodontic HLD Evaluation Form
- Denta Quest Orthodontic HLD Evaluation Form
- Ortho TX Consult form
- Ortho TX Adjustment/Repair form
- Ortho TX Start/Bonding form
- Release of Liability Early Removal of Orthodontic Appliances

FOR OFFICE USE ONLY:ORAL SURGERY FORMS

- Welcome Oral Surgery PROCEDURES
- Welcome Oral Surgery CONSULTATION
- Welcome Oral Surgery Scarsdale
- Advanced Dental Surgery "Tx" Form
- Informed Consent Form for Oral and Maxillofacial Surgery and Anesthesia
- Implant Consent Form
- Anesthesia Record
- Discharge Sheet
 

FOR OFFICE USE ONLY:PEDIATRIC DENTISTRY

- Welcome Pediatric Dentist
- Advanced Dental Pediatric "Tx" Form

FOR OFFICE USE ONLY:ENDO FORMS

- Informed Consent for Endodontic Treatment
- Dentist/Doctor Exuse Letter
- Disclosure sheet for cosmetic or uncovered treatment

FOR OFFICE USE ONLY:GP FORMS

- GP TX Form
 
- Dentist/Doctor Exuse Letter
- Disclosure sheet for cosmetic or uncovered treatment

 

FOR OFFICE USE ONLY:OTHER FORMS

- Advanced Dental "M" Form
- Advanced Dental "I" Form
- Notice of privacy practices Advanced Dental
- Dentist/Doctor Exuse Letter
- Disclosure sheet for cosmetic or uncovered treatment
- Daily sheet


INSURANCES:

1199 646-473-7160 www.1199seiubenefits.org
32bj 516-394-9485  
Aetna 800-451-7715  
CSEA 800-323-2732  
DC37 212-815-1600  
DDS/Magna Care 800-255-5681  
DENTA QUEST/DORAL 800-341-8478  
Delta Dental MASS 617-886-1234  
Delta Dental NY 800-932-0783  
Delta Dental Virginia 800-237-6060  
Dental Shop 888-683-3682  
     
GHI 212-501-4444  
Guardian 800-541-7846  
HIP Carrington 800-477-8255  
Healthplex 888-468-2183  
     
     
     
     
Local 210 866-646-1779  
Local 1180 212-505-5050  
Local 94 SELEDENT 800-520-3368  
     
Metlife Fee Schedule 800-942-0854  
UFT 800-577-0576  

 

 

 

 

 

 


 

ADOBE READER

 

 



Healthplex

  BRONX: DENTAL SPECIALTY REFERRAL FORM
  - Healthplex Referral Form ORTHO-Bronx
  - Healthplex Refferal Form Oral Surgery-Bronx
  - Healthplex Refferal Form ENDO-Bronx
  SCARSDALE : DENTAL SPECIALTY REFERRAL FORM
  - Healthplex Referral Form ORTHO-Scarsdale
  - Healthplex Refferal Form Oral Surgery-Scarsdale
  - Healthplex Referral Form ENDO

237 Willis Avenue, Bronx, NY 10454. Phone:(718) 292-8988; 130 Garth Road, Scarsdale, NY 10583. Phone: (914) 874-5757. email: dds@bronxadvanced.com

The information presented on this site is of personal opinion and consequently is slanted and biased and not based on proper scientific research. The information presented is NOT written by a dental expert. Further the information presented has NOT been subjected to peer review by experts to verify accuracy and data integrity
.Copyright Dental Arts Press. 2011.
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