Forms & Financing

Click below to download our forms. Please fill these out prior to your arrival on your first visit.

New Patient Sheet Form

Financial Arrangements Form

Signature on File Form

HIPPA Disclosure Form

Insurance Worksheet Form

Smile Evaluation Form

Dental Treatment Consent Form

Record Release Form

We will customize financial arrangements to meet your individual needs:

Speedy, electronic insurance claims filing
Long term financial payment plans with outside sources
All credit cards / debit cards
Each insurance claim will be supported by an in-depth narrative and digital x-rays

Financial Partners

We are also pleased to offer CareCredit to our patients. CareCredit is the leader in patient/client financing, and has helped more than 1 million patients/clients get the treatment or procedures they needed and wanted. With a comprehensive range of plan options, for treatment or procedure fees from $1 to over $25,000, we offer a plan and a low monthly payment to fit comfortably into almost every budget.

What Our Patients Are Saying…

I could not have been more pleased with my experience at Dr. Gerlach's office. The friendliness of the staff and professional manner in which I was treated is unsurpassed by any other doctor's office I have ever visited. The doctor and her staff genuinely care about the patient and work diligently to insure that the patient is informed every step of the way. Additionally, they provide a level of comfort and kind, pleasant demeanor I've not experienced in any other health care setting. This office is the standard by which others should be run. Andrew C.

Dr. Lynne's practice is a model of how the business should be run. Patients feel secure that they are receiving the absolute best care in a beautiful and relaxed enviroment. Peter M.

This really sets a new standard in Dentistry and patient care. Dr. Gerlach had confident hands to go along with a gentle touch. Brian S.

It was an absolutely superb experience. Everyone made me feel at ease. Everything was explained in great detail and I felt my issues were addressed with care and concern for my best outcome. Beautiful office, amazingly friendly and knowledgable staff. Thank you!! Crystal R.

What can I say? -- Outstanding!!! Love the fact that Dr. Gerlach is a "teacher" who seems to believe that a patient's understanding of the why and how of oral health is important. Look forward to a long relationship. Jane T.

I really liked the new office, and Jenny did her magic as usual. Keep up the great work. Keith K.

I now feel the freedom to hold happiness loosely because cause it has become okay to smile : ) Cheryl F.

Overall excellent patient care - appreciate the responsiveness when I had a need - exceeded my expectations! Lisa M.

I've never experienced dental care that is executed in such an efficient and heartfelt way. From start to finish, I felt safe and cared for. My teeth have never been cleaner. Scott F.

Many thanks to each and everyone of you for being so professional AND personable! Susan K.

I never thought I would say this about going to the dentist. I actually look forward to going to my appointments. I always leave your office with my spirits lifted 10 fold. I like my appointments early in the morning. It’s just a great way to start my day! Thank you for all that you do each and every day. Jayne S.

The staff is always sensitive to my needs and I feel I always receive excellent service and treatment. Joey A.