Patient Information

New Patients Welcome!

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 below, so you can fill them out online, or download them to print and fill out later. When it comes time to schedule your visit, we’ll work with you to find an appointment that best suits your family’s needs.

New Patients - Family

We look forward to smiling with you!

Schedule your first visit today.

Patient Forms

To make your first visit go as smoothly as possible, you can click on the patient forms below to download and fill out before coming into our Warsaw or Geneseo office!

Online Fillable Patient Forms

Geneseo Online Forms Warsaw Online Forms

Download & Print Patient Forms (PDF)

Geneseo New Patient Forms Warsaw New Patient Forms

Payment Options

Insurance & Financing

We partner with many insurance plans at various levels to help our patients get the care they deserve. We will file your claim for you and schedule your treatment accordingly to help maximize your hard-earned benefits and minimize out-of-pocket expenses.

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.

Full 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.We also offer CareCredit® and Citi Health Card —no-interest or low-interest payment plan based on your financial history.

Bluecross Blueshield Guardian Delta Dental Metlife Emblem Health Excellus Univera CSEA

Office Amenities

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 their oral health and treatment options and inform you every step of the way. After all, the best patient is an informed patient.

Contact Us

If you have any questions about our practice treatment or would like to schedule a consultation with us, please give us a call or request an appointment online today! Dr. Gburek, Dr. Barone, Dr. Moore, and Dr. Hetrick look forward to smiling with you at your next visit to Summit Family Dental Care!

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