These forms are for your convenience. Please feel free to complete the FIRST form listed below, our SECURE ONLINE FORM which is a comprehensive form and includes all the forms listed below OR, you may print any of these forms, complete them and bring them with you on next visit. Any questions, please call 724-834-1644. Thank you.
- Health History (SECURE ONLINE FORM)
- Health History (PDF)
- Notice of Privacy Practice – HIPPA NOTICE (PDF)
- Patient Dental Info. & Insurance
- Endodontic Treatment Consent Form During Covid-19 Pandemic (PDF)
- Informed Consent Form
Our office hours are Monday -Thursday 8am until 4 pm and Friday’s 8 am until 2 pm; from October through March our Wednesday hours are 10 am until 5:15. Emergencies are seen on a daily basis. It is our goal to accommodate each patient to the best of our ability. When scheduling, please note that most treatment is completed in one visit.
We do make every attempt to minimize your wait time; however, emergency cases can arise which may cause a short delay. Please know we like to spend the necessary time with each patient. Thank you for your patience.
If you need to schedule an appointment or have any questions, please call 724-834-1644.
WHAT TO EXPECT AT YOUR APPOINTMENT
Upon arrival, you will be expected to complete patient registration and medical history forms. In order to expedite your appointment, we ask that you provide the following information at the time of your visit:
- Your referral slip
- If applicable, your dental insurance card
Patients can expect to be in our office for approximately 1-1.5 hours. If your treatment requires more time, you will be notified prior to your appointment. Dr. Gillen uses local anesthetic during the procedure so it is not necessary to have someone accompany you to your appointment. There are also no restrictions prior to your scheduled appointment. After your procedure, Dr. Gillen and his staff will review any instructions with you.