Patient Forms

‚ÄčHealth History (print, fill out and bring in)

HIPPA Consent (print, fill out and bring in)

Notice of Privacy Practices (print and keep)

Office Policy (print and keep)


For existing patients, Dr. Gasperini offers expanded hours and additional services not previously offered. He looks forward to continuing to care for you and your family.

For new patients, he welcomes you to his office where your concerns will be heard and you will have his full attention.

 

Prior to or at your first appointment you will be asked to complete a brief health and dental history form for us. 

 

Financial information:

We are a participating PPO provider with Guardian, Aetna, Cigna, Ameritas, Delta Dental, POMCO, and Daniel H. Cook. Please bring your most recent insurance card with you and review your plan so you are aware of any deductible/co-insurance due. Payment is required at the time service is provided. We accept cash, check, and all major credit cards. We also participate with CareCredit. 


If we do not participate with your insurance we can still work with you! Just make sure your plan allows for out of network visits. We will happily fill out an insurance reimbursement form on your behalf so that you will be reimbursed directly from your insurance company. In certain cases a payment plan can be provided to you and we will gladly provide pre-estimates as needed as well.

29 Fox St, Ste. 301

Poughkeepsie, NY 12601

Daniel J. Gasperini, DDS



(845) 471-2311

gasperinidds@gmail.com