Patient Forms & Insurance Information

Please print and complete the following forms:

Please Note:

For the convenience of our patients, West Side Dental Works provides direct insurance billing with most major insurance providers and assistance companies. Please call us at (570) 283-0664 to verify that we can accept your policy. Please bring your insurance information with you to the consultation so that we can expedite reimbursement.

We deliver the finest care at the most reasonable cost to our patients, therefore payment is due at the time service is rendered.  For your convenience we accept Visa, Mastercard, Discover, American Express and Care Credit.   If you have questions regarding an account, you can contact us at 570-283-0664. Many times, a simple telephone call will clear any misunderstandings.

We do bill for most Insurances but payment can take from 4 to 6 weeks, and you are responsible for all copayments and deductibles.

Please remember you are fully responsible for all fees charged by this office regardless of your insurance coverage.