Patient Information
A vital part of providing patients with the right treatment is collecting relevant information about their medical history and current condition.
This information will allow us to develop a personalized treatment plan for your child’s unique needs and preferences. You can provide us with this information by filling out a "New Patient Information Form” before their appointment. Your child should never have to settle for mediocre dental care. Call us today at 561-763-9218 to learn more about our services.
New Patients
It is easy to make an appointment for your initial examination and dental treatments. Call 561-763-9218 to speak with a staff member.
Downloadable Forms:
APPOINTMENT POLICYHEALTH HISTORY FORM
SPECIAL NEEDS FORMFINANCIAL POLICYSOCIAL MEDIA CONSENT
Disclaimer:
By providing my phone number to Fara Bender DMD PA, I agree and acknowledge that Fara Bender DMD PA may send text messages to my wireless phone number for any purpose. Message and data rates may apply. Message frequency will vary, and you will be able to opt out by replying “STOP”. For more information on how your data will be handled, please visit https://www.littleteethbigsmiles.com
Privacy Policy:
No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.
Savings Club:
The Little Teeth Big Savings Club at Fara Bender DMD, PA offers an affordable dental membership tailored for children and teens. With no waiting periods and immediate activation upon sign-up, members receive essential preventive care—including cleanings, exams, fluoride treatments, and emergency visits—plus a 15% discount on additional treatments. Memberships are available for infants (0–2 years), children (3–12 years), and teens (13–18 years), each with a one-time activation fee and monthly dues. This plan is ideal for families without dental insurance, providing predictable costs and quality care. Please note, the membership is not insurance and is exclusive to patients of Fara Bender DMD, PA.
Client HERE for more information
Payment Methods – Check or Cash Accepted
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