Online Forms
Health History Form
As required by law, our office adheres to written policies and procedures to protect the privacy of your information. Your answers are for our records only and will be kept confidential subject to applicable laws. Please note that you will be asked some questions about your responses to this questionnaire and there may be additional questions concerning your health. This information is vital to allow us to provide appropriate care for you. This office does not use this information to discriminate.
Dental Insurance Information
As a condition of your treatment by this office, financial arrangements must be made in advance. The practice depends upon reimbursement from patients for the costs incurred in their care and financial responsibility on the part of each patient must be determined before treatment.
Our Financial Policy
The following form is a statement of our financial policy which we request that you read, agree to and sign prior to any treatment. A copy of this policy will be given to you if requested.
NOTICE OF PRIVACY PRACTICES
This form is an acknowledgement of receipt of notice of our privacy practices.
Photos of the Month
Submitted by Dr. Christopher Root
Photo taken from Talcott Mountain in Avon, CT outside of Hartford, CT.
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Patient Testimonial
I had lost 60 lbs during an extended illness and suffered for months with ill-fitted dentures. After two unsuccessful attempts elsewhere, I heard about Wilbraham Family Dentistry. Dr. Christopher Root did such a thorough job I never needed the customary adjustments. Thanks again Wilbraham Family Dentistry.
- Francis C. -