Online Dental Patient Forms
Our staff looks forward to meeting you and discussing your goals. We strive to keep our appointments on time as scheduled. Prior to your appointment, we encourage you to fill out the patient forms that are located on this website so you can accelerate your check-in process. Please download, print, and complete the forms and bring them with you to your appointment. If you are unable to download our patient forms, then it is recommended that you arrive at your appointment 15 – 30 minutes early so you can have ample time to fill out the appropriate forms.
Online Membership Form
Get treated now and pay over time with Cherry. Cherry is a payment plan designed for your health, beauty, and wellness needs and procedures and allows you to make convenient monthly payments.
CareCredit®, a Synchrony solution, offers healthcare patient payment options for treatments and procedures your insurance doesn't cover.*
*Subject to credit approval. Visit carecredit.com for more information.
Alphaeon Credit is a company that provides patients with a financing option for their elective procedures. Alphaeon features a Budget Pay Plan which sets a fixed monthly payments in addition to their Equal Pay Plan, and No Interest options. Alphaeon Credit has no up-front costs, no annual fees, and no pre-payment penalties.
Membership Information
Now you can join our low-cost dental coverage for a nominal membership fee. Our coverage entitles you to have twice a year exam, 1 limited exam and all necessary x-rays.
All Corrective services are available for small co-payments that are far less than the usual customary fees. You will have 20% savings on all treatment.
Our professional staff is qualified to care for all your dental needs!
No other third-party financing options (such as CareCredit) can be used with these membership savings.
To enroll, simply fill out the enclosed enrollment form and return it with your money order or credit card information. Please make your money order payable to Rabile Family Dentistry.
Low-Cost Dental Coverage*
Individual $288 ~ ($24/month)
Individual &Spouse $456 ~ ($34/month)
Individual &Child $360 ~ ($30/month)
Family plan ( two adults & two kids) $552 ~ ($46/month)
Additional child in Family $96 ~($8/month).
*(This is not an insurance but in office membership)