New Patient Information

Thank You for Choosing Southfield Family Dental Center!

Dentist Accepting New Patients: Patient Forms | Southfield Family Dental - newpatience01Your first visit to Southfield Family Dental Center establishes a vital foundation for our relationship with you.

During your first visit, it's important for us to collect important background information, like your medical history, as well as give you time to get to know your doctor.

To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can even save some time during your first visit by printing out and completing the New Patient Forms in advance of your appointment.

New Patient Forms

Please electronically fill out these forms so we can expedite your first visit:

New Patient Forms:

Medical History Form:

If you cannot fill out the electronic forms please print and fill out the forms below: 

Opens with: Adobe Acrobat
Opens with: Adobe Acrobat


Monday8AM - 8PM
Tuesday8AM - 8PM
Wednesday8AM - 8PM
Thursday8AM - 8PM
Friday8AM - 5PM
Saturday8AM - 3PM

Office Location:

Southfield Family Dental Center

18800 W. 10 Mile Rd
Southfield, MI 48075
Directions chevron_right


(248) 234-9987

Payment & Finance Options

Pay Online: For our patients who prefer to pay online vs in person, we offer the convenience of online bill pay for your dental treatments.

Pay Online (coming soon)

Credit Cards: My Family Dental Center gladly accepts major credit cards as payment for your dental procedure. We accept most major credit cards including Visa, Mastercard, Discover and American Express.

DocPay: DocPay is our in-house financing program that makes dental work more affordable for our patients. With only a small percentage down, patients can schedule recurring payments, up to 12 months, from their checking account or credit cards. This program does not require a credit check. Some restrictions apply. Call today for more information.


Dentist Accepting New Patients: Patient Forms | Southfield Family Dental - 421CareCredit® is here to help you pay for treatments and procedures your insurance doesn’t cover. We offer No Interest financing or low minimum monthly payment options so you can get what you want, when you want it. You can even use CareCredit® for your family and favorite pet.

With three simple steps, including an instant approval process, it’s easy to apply for CareCredit®. After you’re approved, you’re free to use CareCredit® for the services you choose including LASIK, veterinary, dentistry, cosmetic, hearing aids and more.

CareCredit® is endorsed by some of the most credible organizations specific to each healthcare profession we support. And CareCredit® is a GE Money Company, so you know you can count on them. For over 20 years, they’ve been helping over five million cardholders get the healthcare treatments they want and need.

Now you don’t have to worry about saving up for the procedures you want and need. With CareCredit®, the decision is in your hands to get what you want, when you want it. For more information or to apply online, visit