Patient Information

Patient Forms

Please download the following forms (PDF), fill them out and bring them with you to your appointment.

Health History Form

Scheduling and Financial Policy

General Consent Form

HIPAA Notice of Privacy Practices

Insurance Information

Peace Haven Smiles accepts most insurances. Please contact us at (980) 423-1144 so we can look up your specific plan and better inform you of your coverage and benefits.

No Insurance? No Problem

We offer an in-house discount plan and flexible financing options through CareCredit. Please call our office at (980) 423-1144 for more information.