Patient Forms

Patient Forms

Welcome to Loftus Family Dental! To make your first appointment with us as smooth and as efficient as possible, we encourage you to complete our new patient forms in advance. This will save you time at the office and will help streamline your experience. If you have any questions about the forms, please don’t hesitate to contact us. We look forward to helping you schedule your next appointment with our dedicated team.

Ensuring Your Investment in Your Smile With Peace of Mind

At our office, we understand that a smile is a major investment and we want our patients to feel secure in their decision to trust us with their dental care. That’s why we are now offering our patients the Dental Warranty seal of approval.

This seal is only given to select dentists who have proven to deliver the highest quality of care and who can provide a full repair/replacement dental warranty on eligible treatments. Thanks to the Dental Warranty, our patients can now enjoy greater peace of mind when it comes to their dental investments.

With this warranty, patients are protected against unforeseen damage to their treatments that could end up costing them more to repair or replace than what their dental insurance plan originally covered. Even if patients choose to have elective cosmetic treatments, they are still covered, as a chipped or broken porcelain veneer or dental implant could cost thousands of dollars to repair or replace. If a patient experiences a chipped, broken, or failed covered treatment, they can simply return to us and there will be no claim forms to fill out or out-of-pocket expenses up to the amount defined on the Dental Warranty document.

Our goal is to provide our patients with the highest quality of care, and with the Dental Warranty, we are confident that we are doing just that.

Coverage from Dental Warranty Corp:

“No-Fault” Coverage

Repairs or replacement work on qualifying restorations will be covered no matter how it broke, no matter where the patient lives.

“No-Cost” Repair

The warranty through Dental Warranty will cover any repair or replacement of dental work up to the cost of the original restoration.

“Follows Your Smile” Coverage

Even if our patients leave the area, any repairs or restoration replacements are still covered by the warranty. The patient can go to ANY dentist for repair service.

“Constant Assurance”

Even if the doctor is no longer practicing years down the road, our patients’ dental work would still be covered by the warranty.


Imagine not having to worry about paying to repair or replace dental work if something were to happen to your smile. Patients can enjoy this peace of mind for several years because they are covered by this dental warranty.

Patient Responsibility:

To keep the dental warranty in force, the patient must maintain regular hygiene appointments, and come in at least once for a routine exam and cleaning in a 6 month period to ensure oral health and continued care. In addition, patients need to follow the daily hygiene routine recommended to help their dental work last as long as possible.

Loftus Family Dental