Patient Resources
(Click on a Clipboard Link Below for the Forms You Need)
For your convenience, we have grouped together the most commonly used forms and resources, below. Simply select the type(s) of forms to complete by clicking on the applicable patient resources clipboard icon. If you need assistance reading or understanding the forms, please contact our East Main Street Dental office in Shiremanstown, PA, at 717-763-5588.
If you are a new patient who has not yet been seen at our office, please click on the “New Patient” clipboard link and complete/submit the patient information forms. The forms will open in a new tab and be submitted securely to our office. Thank you.
We maintain a HIPAA (Health Insurance Portability and Accountability Act) compliant privacy policy. Please click on the “HIPAA Notice of Privacy Practices” Clipboard to view, download and print our Privacy Policy. The forms will open in a new tab and be submitted securely to our office. Thank you.
Financial & Insurance Info
To file your payment information or an insurance claim, please click on the “Financial and Insurance Info” Clipboard to learn about payment options and to enjoy discounted billing by joining the PDC Dental Membership Club. Thank you.
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Contact Information:
East Main Street Dental
205 East Main St.
Shiremanstown, PA 17011
Phone: 717-763-5588
Office Hours:
Mon: 9 AM – 5 PM
Tues: 8 AM – 4 PM
Wed: 8 AM – 6 PM
Thurs: 8 AM – 5 PM
