Not Accepting New Patients At This Time
Patient Registration Forms
Please print and complete the forms below. Then bring the completed forms to your initial appointment.
Payment Types
- We accept checks, Visa, MasterCard, Discover and CareCredit.
- CareCredit is a financial plan with several repayment options, one of which is 6 months of interest-free payments. Call us for information.
Financial Policy
- Payment expected at time of service.
- There is a 1.5% monthly fee on balances due past 60 days.
- A $50 fee will be charged to patients who “no-show” for their appointments.
Dental Insurances
We are not contracted providers with any insurance companies and fees are due in full at time of service. However we can help you submit the necessary forms for insurance reimbursement checks to be sent to you. The reimbursement check will be sent to either you or Ithaca Dentistry depending on the policy of your insurance company.
