NEW PATIENT FORMS

(Please print, fill out and bring these four forms
to your first appointment at Pi Dental Center.)

Medical History Form in PDF Format

Patient Personal Dental Needs Questionnaire

Private Contract Agreement

HIPAA

HIPAA Consent In PDF

 

 

Pi Dental Center Phone: 215-646-6334
Pi Dental Center Fax: 215-643-1149
Toll Free Number: 1-800-PITEAM-5

MAP

Services normally provided during a new patient's first visit:

Complete diagnostic work-up includes the following:

  • Review of Medical and Dental Histories

  • Full Mouth X-rays

  • Panorex X-ray

  • Diagnostic casts

  • Periodontal exam and charting

  • Tooth color analysis

  • Diagnostic Photographs

  • Cancer screening

  • Bite registration and occlusal analysis

  • Clinical Evaluation and Consultation

  • Tentative Treatment Plan

  • Oral hygiene treatment (optional/additional charge)

  • Lateral Cephalometric X-ray (optional/additional charge)

  • iCAT CT Scan (optional/additional charge)

Financing Options

Office Hours:
7:30 a.m. to 4:30 p.m.
Monday through Thursday

Other Patient Forms

 

Request More Information

ASK A DENTAL QUESTION