Enrollment Packet Completion

An enrollment packet must be completed for each patient that is receiving care from Accessible Dental Services.  The packet serves to gather demographic information, insurance information, medical history information, as well as, all the necessary consents.  The packet can either be mailed or faxed.

 

Fax Information:
Please fax the completed enrollment packet to: 724-772-9642

It can also be returned by mail to:

    Accessible Dental Services
    163 Thorn Hill Road
    Warrendale, PA 15086
    Attention: Karen Noah

Important Note: It is necessary to return the packet at least 10 days prior to the scheduled appointment day to ensure that the anesthesiologist, the dentist and the Director of Operations can review it.

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