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New Patient Information

Your First Visit

If you’re getting ready for your first appointment at the Medina, OH dentistry practice of Allan J. Milewski, DDS, our team would like to welcome you to our dental family. We can’t wait to get to know you and your loved ones through years of outstanding dental care. During your first appointment at our office, you can expect to be greeted with warmth by every member of our team. We’ll be happy to answer any questions you have and help you feel right at home. Please don’t hesitate to ask for anything you need. We’ll review your new patient information forms to ensure their accuracy and help you to complete them when necessary. Then, we’ll capture necessary x-rays and digital images, examine and clean your teeth, and partner with you to set up a personalized plan for your ongoing dental care. We can’t wait to see you in our Medina, OH office. Please call our team to find out more or schedule an appointment.

New Patient Forms

Printable Forms

We have made our new patient forms available to you as Adobe Acrobat files. Double click on the forms below, and print them at home. Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our Medina dental office and we will gladly send or fax them to you.

New Patient Registration Health History Dental Health History Notice of Privacy Practices Financial Policy

Online Forms

If you prefer, you can complete your new patient paperwork online. Please click on the links below to fill out each of our five secure forms before coming to the office.  After completing the forms, be sure to click submit for each individual form to send the forms to us!

Patient Registration Patient Dental Health History Patient Health History Notice of Privacy Practices Financial Policy

Insurance Accepted

If you have dental insurance, our knowledgeable team will be happy to help you maximize your coverage. We are in-network providers with Delta Premier. Additionally, we process and file claims for most major benefit plans. If you have questions about your specific coverage, a member of our team will be happy to evaluate your coverage and help you make the most of your plan. Please don’t hesitate to contact our team at any time before your appointment to find out more.

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Financing Available

Our knowledgeable team will do their utmost to provide accurate estimates of your insurance coverage, and we accept payment for the out of pocket costs associated with your care at the time of service. We take payment in cash, check, or major credit cards. Additionally, we can work with CareCredit to provide low and no interest financing plans for qualified patients. Click the link below to apply for pre-approval, or ask about CareCredit during your next visit.

 Apply For CareCredit


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Complete Patient Forms

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