Patient forms

Term Loan Option: We offer, upon approval, low-interest loans up to 6 months through Care Credit many times with no down payment, no annual fee, and no prepayment penalty. We can complete your application online for you and have a decision in minutes. If you prefer, you can follow the links below to complete your application process and get immediate determination results, all from the privacy of your own home.

Apply Now Online by clicking  "Care Credit application".



information on dental insurance

payment PLAN options

Payment & financing

Welcome to our website! We are looking forward to meeting you and serving you. Please feel free to contact us for any questions or download our forms below. For new patients with insurance, please bring all dental insurance information with you. Thank you.

Payment at 1st Appointment Option: Payment in full is preferred when services are rendered, unless prior arrangements (one of the above options) have been made. No accounting courtesy will be extended for those choosing this option. Additional details provided in office. Come in and see what we can do for you.

We Care About You! 

Call (734) 662-6772

Please Select the following patient form, download, print, complete, and either bring in to our office the day of your appointment or e-mail us a copy on our HIPAA compliant E-mail address. All new patients who do not download and complete prior to the first visit are required to arrive 15 minutes early to their appointment for paperwork completion. Thank you! We are happy to help you!

Valentine Dental Care is proud to be an unrestricted insurance provider, meaning that no matter what insurance plan you have, we will help you maximize your insurance benefits. Part of your first visit with our office is review treatment needed and how to use your insurance benefits efficiently. Most insurance fee coverage can be provided as an estimate. Our relationship is with you and not your insurance company.

We accept many dental insurance policies including Delta Dental, CIgna, and others. If you have dental insurance, we will file your claim as a courtesy. Despite this fact, no insurance plan covers everything, so we have a payment plans available through Care Credit to assist you in achieving your dental health goals. Our job is to be your dental consultants and provide you options that will allow you to reach your dental health goals. The treatment you receive is your choice and it s your responsibility to know your policy. We are happy to assist you in accomplishing your goals and answer your questions as best we can.

At Valentine Dental Care, we know the importance of regular dental treatment for overall health and wellness. Offering quality dental care with premier products at a price that you and your entire family can afford is also important. For this reason, we offer a variety of payment options to help you fit the dental care you need into your dental budget. For your convenience, we gladly accept, cash, check, or Discover, VISA, or MasterCard for payment of all fees and treatment.