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Patient Forms

We are excited to meet you and help you and your family achieve the healthy smiles they deserve.

Financial Information

At the Fairfield Dental Clinic, we make every attempt to make dental care affordable. Because of our philosophy, we always recommend having all treatments completed as soon as possible, so you don’t fall into the one-tooth-at-a-time fix-me cycle of patchwork dentistry. We realize that high-quality dentistry is not inexpensive, but we want to give all of our patients the opportunity to say yes to comprehensive treatment, so we have several payment options to make dentistry more affordable for you!

  • Cash
  • Check
  • MasterCard, VISA, Discover Card
  • Insurance Assignment (as a courtesy, we will file your insurance claims for you)
  • Care Credit – The payment option for healthcare services.

Nitrous Oxide

Nitrous oxide is available at our office for an additional charge. If you are interested in using nitrous oxide analgesia, please discuss this option with your dentist. Please also mention if you are pregnant, or think you might be pregnant.

Fairfield Dental Clinic

51 West Adams Avenue
Fairfield, Iowa 52556

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