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  • Who We Are
    • About ADS
    • Why Choose ADS
    • Message from Rick D. Senft
    • Meet the ADS Team
  • Services
    • Types of Dental Treatment
    • Mobile Dental Unit
    • Insurance
  • Resources
    • FAQs
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    • Getting Started with ADS
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  • Who We Are
    • About ADS
    • Why Choose ADS
    • Message from Rick D. Senft
    • Meet the ADS Team
  • Services
    • Types of Dental Treatment
    • Mobile Dental Unit
    • Insurance
  • Resources
    • FAQs
    • Testimonials
    • Patient Forms
    • Getting Started with ADS
  • Contact Us
    • Main Office
    • Clinic Locations
    • Mobile Dental Unit Partner Sites
Resources

Patient Forms

Please download and complete the applicable patient forms below.  For any questions about the forms, please contact us.

New Patients:

  • New Patients Form

For new patients, please return the completed Enrollment Packet to ADS at your earliest convenience.  New patient appointments will be scheduled upon receipt of the Enrollment Packet.


Returning Patients:

  • ADS COVID-19 Release Statement Form
  • Private Pay Agreement
  • Consent for Comprehensive Dental Treatment Form
  • Consent for Anesthesia Administration Form (Sedation Appointments Only)

For returning patients, please return the completed forms at least 30 days in advance of your appointment, and notify ADS immediately of any changes to the information contained within.

  • FAQs
  • Testimonials
  • Patient Forms
  • Getting Started with ADS
  • FAQs
  • Testimonials
  • Patient Forms
  • Getting Started with ADS

Accessible Dental Services, Inc.

641 Reno Street
Rochester, PA 15074 USA

Phone: (724) 775-0448 x633

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