Patient Information

At Summit Family Dental Care, we believe in enriching our patients’ lives with high-quality dental care designed for comfort and convenience. All the forms you need are available through this website, so you can fill them out here, or download them to print and fill out later. In addition, this website offers downloadable information about our Warsaw and Geneseo practices’ policies, guarantees, and patient financing. When it comes time to schedule your visit, we’ll work with you to find an appointment that best suit your family’s needs.

Patient Forms

To make your first visit go a little more quickly, you can click on the patient form below to download and fill it out before coming in to our Warsaw or Geneseo Dentist office!

Online Patient Form

Online Geneseo Patient Forms Online Warsaw Patient Forms

Downloadable and print Patient forms

Geneseo – New Patient Forms Warsaw – New Patient Forms


We participate in various plans and at various levels with:

* GHI Preferred
* Metlife PPO
* Delta Premier
* Guardian
* Univera
* Blue Cross/Blue Shield
* Excellus

We work with a wide variety of other insurance providers as well, and assist you by submitting claims directly to your carrier.

In addition, we will calculate for you in advance your co-payment for treatment. You will then only be required to pay your portion of the fee at the time the service is rendered.

CareCredit LogoFull payments or co-payments are expected at the time of service unless other arrangements have been made in advance. We accept cash, check, Visa, Mastercard and Discover. citihealthWe also offer CareCredit and Citi Health Care —no-interest or low-interest payment plan based on your financial history.


To make your visit more comfortable we offer in-room TVs and music so while in the dental chair you can watch a wide array of movies, educational videos or simply relax to soothing sounds. Our educational videos are designed to educate our patients about treatment options and inform you every step of the way. After all, the best patient is an informed patient.

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