Forms and Finances
Medical Forms and Payment Information
Please print these forms, fill them out, and bring them to your first visit with Dr. Rogers. This will help to expedite the check in process, so we can begin enhancing your smile right away.
Payment Information
We offer a variety of payment options, including MasterCard, Visa, Discover, CareCredit and CITI Health Card. CareCredit and CITI Health feature 0% interest for up to one year and extended payment plans for those who qualify. Payment is due at the time services are rendered.
Dental Insurance
Dental insurance can be confusing, but we'll make it easy for you. Simply bring your card or claim into our office, or call to speak with our friendly insurance assistant. We'll be happy to estimate what your insurance will cover and file your claim for reimbursement on your behalf.
Affordable Financing
We don't want finances to keep you from getting the care you need. Dr. Rogers has partnered with CareCredit and CITI Health to bring you affordable financing options. To pre-qualify for an instant line of credit, click on one of the following links:
Features & Benefits
- No down payment
- No annual fee
- Interest-free for up to 12 months
- Flexible payment plans
- Revolving credit for other dental, medical, and vision procedures.
- Easy online payment options
If you have any questions about forms, insurance, or financing, don't hesitate to call our dental office. We're here to help you get the care you need under any circumstances. Smiles by Design treats patients from Honesdale, Waymart, Narrowsburg, Hawley, and the NEPA area.
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