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 use the following instructions:

1. Choose the form for the location where you receive dental care.
2. Please provide the information requested on the form as completely as possible.
3. Print out a paper copy of the form and bring it with you on your next appointment.

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 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.

UDHS also accepts American Express^®, Discover^®, VISA^®, MasterCard^®, and MAC cards.

 

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

Download the HIPAA Notice for all of our clinics >