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Home » Patient Forms »

Patient Forms

For your convenience, we now offer online forms.

Please click the link below to view and complete our forms.

NEW PATIENT FORMS

Please click here to view our Notice of Privacy Practices.

Contact Us

221 S. Eddy St.
South Bend, IN 46617

(574) 234-4335

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CareCredit

We offer Care Credit Financing which has 12 months FREE financing on all dental services. Please click below to review Care Credit’s website and application information. It’s easy to apply and approval is just a click away!

CareCredit

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Contact Us

ADDRESS:
221 S. Eddy St.
South Bend, IN 46617

PHONE: (574) 234-4335
FAX: (574) 232-7675

OFFICE HOURS:
Monday – Thursday:
8 am – 5 pm

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