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Foulk Road & Park Place Dental Associates
Creating Healthy Smiles in Delaware

New Patient Inform/Paperwork

Dear New Patient,

We are happy to welcome you to our dental practice and appreciate the opportunity to care for you and your family.

Your first visit is scheduled with our Doctor for a comprehensive exam complete with dental radiographs* to evaluate your overall oral health.  If it is determined that you need any dental treatment, a treatment plan and estimate will be prepared for you prior to the beginning of any procedures.

The following items will be needed for this appointment:
     Completed new patient paperwork (2 links below for pdf file)
     Acknowledgment of Privacy notice (link below under Hippa Info)
     Any x-rays from previous dentist, ie
         Bitewing x-rays (12 months or less)*
         Panorex or full mouth series of x-rays (3-5 years or less)*
     Dental insurance card/information

After this appointment, we will then schedule your hygiene (cleaning) appointment.

We look forward to meeting you at your appointment.

Sincerely,
The Doctors & Staff of Park Place and Foulk Road Dental
Dr. Nicholas Russo, Sr.    Dr. Nicholas Russo, Jr.   Dr. Michael Duffy   Dr. Edwin Kuipers and
Dr. Michael Bojarski

*Please Note: Please contact your previous dental provider and have them forward any x-rays to our office prior to your appointment to avoid possible additional charges.  Digital x-rays can be emailed to parkplacedental210@gmail.com or mailed directly to our office.


Health History

HIPPA Info