Forms & Finances

New Patient Forms


Please complete the three forms linked below and press the submit button to electronically and securely submit your registration information. If you have X-rays, records, or an insurance card, please present them when you arrive.

  1. Registration – page 1
  2. Registration – page 2
  3. Registration – page 3

Dental Insurance

For people who have dental insurance, we file claims as a courtesy. Dr. Galligan is in network with Delta Dental Premiere, we file dental insurance claims as a courtesy to our patients with dental benefits. Our practice is in network with Delta Dental Premiere, but we also file, verify benefits, and thoroughly assist with out-of-network claims for most insurance companies. Please prepare to pay your co-payment and/or deductible at your visit.

Financing & Payments

Nothing should deter you from professional dental care. Your overall health, image, and quality of life depend in part upon a healthy, attractive smile. To make the financial side of dental care easy for you, we accept cash, checks, and credit cards.

If you’re in need of a convenient payment plan for your treatment, our office also partners with CareCredit.