Patient Registration

Patient Registration

Schedule an Appointment
The first step towards a beautiful, healthy smile is to schedule an appointment.  And, we know that you have many choices when choosing a dentist in Lake County so we have made requesting an appointment a simple process via our Web site.  If, for any reason you cannot keep a scheduled appointment, or will be delayed, please call us as soon as possible.

You can also save time by completing forms in advance of your appointment,  We’ve provided a link below to access registration forms.

Patient Forms
Please print and fill out these forms so we can expedite your first visit:

Patient Registration Form

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

In order that we may respond to your unique needs and concerns, we will ask that you complete a medical history and dental questionnaire.  If you have dental insurance, be sure to bring that information with you to your first visit as well.  

Insurance Information
At Fioritto Family Dental, we understand the complexities of dental insurance.  We have a qualified team of individuals that will research your personal plan so that you are given the best estimate as possible when dental treatment is needed.

We accept all PPO plans and will file insurance claims on your behalf.  Any amount not estimated to be covered by your insurance becomes the responsibility of the patient.  Your estimated patient portion is due at the time of service. You will not be held liable for any insurance charges until 30 days after the date of service.  If, after 30 days, your insurance has not paid in full, the entire balance becomes your responsibility. Please remember that we do our best to determine your coverage levels, but your insurance policy is between you and your insurance company, not with the insurance company and your doctor.

Fioritto Family Dental is directly contracted with Assurant, Cigna, Connection Dental and Careington.  

Financing Information
CARECREDIT: If you would like to finance your dental expenses, we would be more than happy to provide you with information from Care Credit or you can visit their website at


  • A wide array of monthly payment options to help you reach your individual goals
  • Special financing plans that are not always readily available with traditional credit cards
  • The ability to use your card again for yourself or family members with no need to reapply and no annual fee

Your Best You is Closer than You Think!

DISCLAIMERS –  *Subject to credit approval and availability. Purchase must be made using the ALPHAEON CREDIT Card Account. ALPHAEON CREDIT Card Accounts are offered by Comenity Capital Bank which determines qualifications for credit and promotion eligibility. Account must be in good standing at the time of purchase. At no time will the minimum payment due be less than $27.00. Minimum interest charge is $2.00 per credit plan. Standard variable APR of 28.99%, based on the Prime Rate. Comenity Capital Bank issues ALPHAEON CREDIT Card Accounts which can be used with participating physicians.