Patient Registration-New Patient Forms
Scott A. Reef, DDS, MSD and Justin J. Villanueva, DMD, MSD, DHL — Periodontal Associates of Lafayette IN
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765-447-9319 Schedule Your
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Our Office Hours: Monday - Wednesday 8:00 AM - 5:00 PM, Thursday 8:00 AM - 3:00 PM, Friday 8:00 AM - 12:00 PM
Insurance/Guarantor Information Form
We have an “Opt-out” status with Medicare. We cannot file claims with Medicare, nor can our patients for treatment. Dental procedures are not normally cover under traditional Medicare.
Release of Health Records
Print, fill out, and mail, e-mail, or bring to office for release of records to another specified entity.
Established Patients of Record