New Patient Information and Forms

Welcome to Willis Dental! We take our partnership in your oral health very seriously. Before we start your treatment, we will need some information on your personal medical history and financial information to better serve you in our office. Please fill out your forms and submit electronically below. All information is kept strictly confidential.

We look forward to seeing you in our office!

If you have previous dental records you would like transferred to our office, please print the below form and email to us at [email protected] or bring to your appointment:

Payment options:

Cash, Check, Credit Card-Visa, Master Card, Discover and American Express, Care Credit


5% cash discount- no insurance payment made with check or cash

5% Senior Citizen discount for patients 65 years and older

Insurance Network Participation:

  • Delta Dental / MODA- Premier, Preferred and Exclusive
  • MetLife
  • LifeMap
  • Regence Blue Cross Blue Shield
  • Cigna-PPO
  • Ameritas
  • Assurant
  • LifeWise
  • Standard
  • United Concordia
  • Aetna
  • Guardian
  • DenteMax Network
  • Connection Dental-GEHA

As a courtesy, please call with your insurance information and we will check your benefits prior to your appointment.

Please note that you are responsible for the fees charged by our office, no matter what your insurance coverage may be. As a courtesy to you we will bill your insurance company and track claims.  If financial arrangements are needed it must be discussed with the Accounts Manager prior to your treatment. 

Our Location

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Hours of Operation

Our Regular Schedule


8:00 am-5:00 pm


7:00 am-5:00 pm


7:00 am-5:00 pm


8:00 am-5:00 pm


8:00 am-2:00 pm