Financial Options

At the dental office of Joseph A. DeLapa, DDS, we want you to receive excellent dental care with payment options that meet your family’s financial needs. As part of this commitment we accept:

  • Cash
  • Personal checks
  • Discover
  • Visa
  • American Express
  • MasterCard
  • Citi Health Card
  • CareCredit

Citi Health Card and CareCredit are third-party financing options that offer low- and no-interest payment plans. For patients with dental insurance, our friendly dental team will also help file your insurance papers for reimbursement. For information regarding our financial options, we invite you to contact our South Salem, New York dental office today. We look forward to serving you!

Citi health cardCare Credit Icon

 

Patient Forms

We want you to have a positive experience each time you visit our dental office in South Salem, New York. Below, you will find a listing of required forms for both new and returning patients. Click the name of each form to view and then print a copy of it out. Please bring the completed forms in with you on your next office visit. If you have any questions, please feel free to contact our dental team for assistance. We are always happy to help!

(All forms are required for new patients. Forms marked with an asterisk (*) are required for returning patients.)

Health History Form

Authorization to Treat a Minor

Responsible Party

Financial Policy

*Notice of Privacy Practices

*Notice of Privacy Practices Acknowledgement

Smile Analysis