Save time during your first appointment at The Guter Center for Family & Cosmetic Dentistry by completing our new patient forms in advance. Our patient forms are available on this page. If you have any questions, please contact our team at the office of Dr. Hans Guter. We are eager to accommodate you! Schedule your next appointment with our dentist in Circleville, Ohio, today.
- COVID-19 Consent Form – Download and Print OR Fill Out Online
- HIPPA Acknowledgement – Download and Print OR Fill Out Online
- Patient Information – Download and Print OR Fill Out Online
- Dental and Medical History – Download and Print OR Fill Out Online
- Image Release Form – Download and Print OR Fill Out Online
- Velscope Consent – Downaload and Print OR Fill Out Online
- Botox Informed Consent – Download and Print OR Fill Out Online
- Botox Post Instructions
- Botox Pre Instructions
We want to make the payment process as convenient as possible for you. We accept check, cash, credit card, and debit card. Our trained staff will assist you with the necessary forms to that allow you to receive the benefits your insurance provider offers. We will also submit insurance claims for you. Please come prepared to our office with your insurance information and allow time before your visit so we can discuss payment and insurance with you. We are happy to answer any questions you may have. Please feel free to call us with any concerns.
To help make our services more affordable to our patients, we offer CareCredit, a third-party payment option that allows you to pay for your treatment in a low-interest or interest-free monthly plan. To learn more and apply for CareCredit, please click the link below.
Quality Dental Plan
We are proud to offer Quality Dental Plan — a dental savings plan for both new and existing patients in our practice. Knowing that traditional dental insurance premiums are expensive, and that insurance benefits are extremely limited, we have partnered with Quality Dental Plan to create a comprehensive and customized savings program that will cover all of your preventive care, like cleanings, x-rays and exams, at 100% in our practice. When you enroll, you’ll also receive valuable benefits on restorative care, like fillings and crowns. Contact our office for more details.