PATIENT FORMS
Going to the dentist can be an overwhelming experience, especially on your first dental visit. Let us put your concerns and anxieties to rest. Our goal at Vayner Family Dentistry is to make every patient experience as comfortable as possible.
To make your visit as pleasant and brief as possible, there are a few things you should bring with you. Please bring your dental x-rays from the last six months to your first appointment.
With just a few simple forms, we’ll ask for relevant medical history, any medications you might be taking, your dental history, and any dental insurance coverage you may have.
Want to get a head start? Download or fill in the new-patient forms below.
These documents are also in Adobe PDF format. If you’re unable to read PDF files, please download free Adobe Acrobat Reader here.
AFFORDABLE DENTISTRY IN FAIRFIELD
PAYMENT METHODS

Cash

Check

AMEX

Discover

Mastercard

Visa
WE ACCEPT

Dental Insurance
We’re an insurance-friendly practice and we’re in network with several providers. To eliminate additional steps on your end, we’re happy to track, file, and update your claims for you. Rest assured, our goal is to minimize your out-of-pocket expenses and maximize your coverage.

Dental Savers Plan
For those without insurance, we also offer our in-house dental savers plan. For just $25 per month, this plan is designed to cover your routine preventive care and give you discounts on additional dental treatments. Plan membership includes two exams, x-rays, and cleanings, as well as one emergency exam.

CareCredit ®
For additional assistance with out-of-pocket expenses, we also offer customizable payment plans through CareCredit. This financing option functions like a credit card, but can only be used for healthcare expenses. You’ll be able to cover the cost of treatment upfront and pay for your care over an extended period of time. Apply today!
DENTAL SAVERS PLAN VS. DENTAL INSURANCE
DENTAL SAVERS PLAN
LOW MONTHLY PAYMENTS

Two X-Rays

Two Cleanings

Two Exams

One Emergency Exam