Enrollment Packet

Enrollment Packet Completion
An enrollment packet must be completed for each new 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 completed enrollment packet can returned either by mail or fax.

How Do I Get An Enrollment Packet?
To receive an Enrollment Packet please use the Contact Us form or contact Karen Noah directly:

Accessible Dental Services, Inc.
Attention: Karen Noah
641 Reno Street
Rochester, PA 15074
Phone: (724) 775-0448 x633
Fax: (724) 772-9642
Email: [email protected]

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.