Patient Information

Dental care for your family – Thank you for choosing Fairfield Dental Clinic. We are excited to meet you and help you and your family achieve the healthy smiles they deserve.

Patient Forms

We have made our patient forms available to you as Adobe Acrobat files. For your convenience, we recommend printing and completing these forms at home.

Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our office and we will gladly send or fax them to you.

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 treatment 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)
  • Platinum Financing – On-the-spot financing
  • 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.

Language Assistance Services

If you would like to find out additional information on any of these or other services, please visit the American Dental Association.

Fairfield Dental Clinic

51 West Adams Avenue
Fairfield, Iowa 52556

Fairfield Dental Clinic

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