Patient Forms

If you are a new patient to our office, the attached files contain our new patient forms that will need to be filled out prior to arriving our Seymour Dental office. Filling them out prior to arriving allows us to attend to you more quickly vs. completing them upon your arrival. Thank you and please call our office at (920) 833-2215 should you have any questions at all.
 Financial Information

Seymour Dental does participate in some dental insurance plans and we would be more than happy to prior authorize any or all work that you need. We always attempt to maximize the patient's benefit, but insurance plans vary greatly and we are unable to keep up with all changes that your provider may make. We ask that if you have any questions pertaining to your coverage that you contact your carrier directly. Please read through the following page and call our friendly office staff if any questions arise.

Payment for treatment is needed the day of procedures.

Financial Options
  1. Cash or check with appropriate ID verification.
  2. Credit Card - Mastercard, Visa or Discover.
  3. Care Credit - third party financial institution offering 6 or 12 month 0% interest (if paid in full within promotional period) on amounts greater than $200.00. Contact the office for more information or go to to begin an application today.

**We will gladly submit all of your dental insurance claims after treatment has been rendered, however your estimated portion is expected on the day of service.**