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132 North Park Avenue, Rockville Centre, NY 11570
(516) 678-1316
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  • Home
  • About Us
    • Our Office
    • Meet The Team
    • Comfort Menu
    • Blog
  • Our Doctors
    • Keith Hasday, DDS
    • Brian Goldberg, DDS
    • Lary Verasco, DMD
    • David Chen, DMD
    • Andrew Jacobson, DMD
    • Luke Soletic, DDS, MD
    • Peter Zhao, DDS
    • Phoebe Jang, DDS
  • Services
    • Bone Grafting
    • Crown Lengthening
    • Dental Crowns & Bridges
    • Dental Hygiene
    • Dental Implants & Implant Restorations
    • Extractions
    • Frenectomy
    • Gum/Osseous Surgery
    • Invisalign® Orthodontic Treatment
    • Invisalign SmileView
    • Porcelain Veneers
    • Root Canal Therapy
    • Scaling & Root Planing
    • Sedation Dentistry
    • Sinus Augmentation
    • Soft Tissue Grafts
    • Emergency Dentistry
    • Botox (Medical & Aesthetic)
    • Lip Fillers
    • Oral Surgery
  • Patient Info
    • New Patient Forms
    • Insurance & Financial Info
    • Finance Your Dental Care
    • Post-Op Instructions
    • Make a Payment
  • Request Appointment
  • Review Us
  • Careers
  • Contact Us
    • Contact Us
  • Emergency Dental Care
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New Patient Forms

English Español
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We look forward to welcoming you to our practice. The below forms are required to be completed prior to your first visit. You may either print and complete the forms and bring them with you, scan and email them to us, or arrive 10-15 minutes prior to your appointment and complete them in office.
NEW PATIENT REGISTRATION & MEDICAL HISTORY FORM

HIPAA FORM
FINANCIAL POLICY FORM
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Hours

Monday 8:00 am - 6:00 pm
Tuesday 8:00 am - 6:00 pm
Wednesday 8:00 am - 8:00 pm
Thursday 8:00 am - 6:00 pm
Friday 8:00 am - 1:00 pm
Saturday 8:00 am - 1:00 pm

Location

132 North Park Avenue, Rockville Centre, NY 11570

(516) 678-1316

© 2026 Rockville Centre for Dentistry. All rights reserved. | Accessibility | Sitemap | Privacy Policy
  • Home
  • About Us
    • Our Office
    • Meet The Team
    • Comfort Menu
    • Blog
  • Our Doctors
    • Keith Hasday, DDS
    • Brian Goldberg, DDS
    • Lary Verasco, DMD
    • David Chen, DMD
    • Andrew Jacobson, DMD
    • Luke Soletic, DDS, MD
    • Peter Zhao, DDS
    • Phoebe Jang, DDS
  • Services
    • Bone Grafting
    • Crown Lengthening
    • Dental Crowns & Bridges
    • Dental Hygiene
    • Dental Implants & Implant Restorations
    • Extractions
    • Frenectomy
    • Gum/Osseous Surgery
    • Invisalign® Orthodontic Treatment
    • Invisalign SmileView
    • Porcelain Veneers
    • Root Canal Therapy
    • Scaling & Root Planing
    • Sedation Dentistry
    • Sinus Augmentation
    • Soft Tissue Grafting
    • Emergency Dental Care
    • Botox (Medical & Aesthetic)
    • Lip Fillers
    • Oral Surgery
  • Patient Info
    • New Patient Forms
    • Insurance & Financial Info
    • Finance Your Dental Care
    • Post-Op Instructions
    • Make a Payment
  • Request Appointment
  • Review Us
  • Careers
  • Contact Us
    • Contact Us
    • Emergency Treatment