New Patient Info

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Online Patient Forms

Patient Registration (Form may take a few moments to load…)
Medical information (Form may take a few moments to load…)

Printable Patient Forms

Adult Patient Forms
Child Patient Forms

The following below is a form to release your current record from Dr. Anderson's office to your new dental provider.  We would like to take this opportunity to say thank you for your loyalty to our office while you were in the Champaign area and good luck with your move.   

Records Release

This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Payment Options

For your convenience, we accept cash, debit cards, personal checks, money orders and major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.


As a service to our patients, our practice accepts most dental insurance programs, including non-managed care, indemnity (traditional) and PPO out-of-network. We are not part of any managed care network. Our accounting staff will prepare all the necessary forms for your dental benefits. However, we remind you that your specific policy is an agreement between you and your insurance company. Please keep in mind that you are responsible for your total obligation should your insurance benefits result in less coverage than anticipated. Our staff will gladly submit a pre-treatment estimate to your insurance company so that you will know what your benefits will be. 

The fees charged for services rendered to those who are insured are the usual and customary fees charged to all our patients for similar services. Your policy may base its allowances on a fixed fee schedule, which may or may not coincide with our usual fees. You should be aware that different insurance companies vary greatly in the types of coverage available. Also, some companies take care of claims promptly while others delay payment for several months. 

Dental insurance is a wonderful benefit that helps many of our patients improve their access to dental care. As a service to our patients, we work will all insurance companies to help you maximize your reimbursement. Dental insurance typically allows you to choose any dentist but some will pay a lower percentage of the fee if you choose a dentist “out of network”. If your policy has a list of “participating providers” then we would be considered “out of network”. This may increase your out of pocket dental costs but our patients have found that this cost is offset by the high level of service and care that we provide at Anderson Dental.

We will process and submit your insurance documentation to help you get reimbursed promptly. Our staff will gladly submit a pre-treatment estimate to your insurance company if you would like to know more precisely what your benefits will be before proceeding with any needed dental care.

Our fees for services are the same whether a patient has insurance or not. Your insurance policy may reimburse you based on a percentage of charges or based on a fixed fee schedule. Insurance companies vary greatly in their reimbursement rates, covered procedures, and promptness of reimbursement. Some companies reimburse within weeks while others are currently longer than a year. If you have questions about your particular insurance plan, please don’t hesitate to ask.