UDHS New Patient Forms & Insurance Information

New Patient Forms

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Sending information to UDHS

Please complete the form for the location where you are receiving treatment. Please using the following instructions:

1. Choose the form that you would like to submit.
2. Fill in the information as completely as possible.
3. Print out a copy of the form and  bring it with you on your next visit.

All locations

• Patient Medical and Dental History form

Salk 3189 location

• Patient Registration

Oral Surgery

• Patient Registration

Montefiore

• Patient Registration

Insurance Information

UDHS accepts Medicare and many other commercial insurance programs. If you have any questions about insurance coverage, contact your insurance carrier or one of UDHS' financial counselors at 412-648-9100.

The practice also accepts American Express, Discover, VISA, MasterCard, and MAC cards.

Other options for patient payments include CareCredit^® or The Medical Bureau. These two valuable tools can be a financing option for patients to obtain the dental care they need.  One of our financial counselors can assist you with this or you can contact CareCredit^® or The Medical Bureau directly on their websites for information:

• Care Credit
• The Medical Bureau of Pittsburgh

You may download HIPAA notices here for all of our clinics.

Download the HIPAA Notice for all of our clinics >