Find all of the information you need here!

We have made your account, patient forms and appointment request forms available online for your convenience.

Parent Resources - Clifton Pediatric Dentist NJ - Banner

Parent Resources

We accept the following insurance providers:

New Patient Forms

Our New Patient Forms are now available online so you can complete them at your leisure - saving you time waiting in our office and giving you the chance to carefully review our policies and procedures.

Click here to print your new patient forms >> NEW PATIENT FORMS

Click here to print your HIPAA consent forms >> HIPAA CONSENT FORM


At Clifton Pediatric Dental Care, we are committed to providing quality and affordable dental health care. You have multiple options for payment available. For your convenience we accept cash, check, participating insurance, major insurance, Visa, MasterCard and Discover. We understand that unexpected dental bills can sometimes strain finances. If this happens, talk with us immediately by calling us at
973-473-7377. If you help us keep the lines of communication open, we can work out acceptable arrangements.

Appointment Request Form

To schedule an appointment at Clifton Pediatric Dental Care you may call our office at 973-473-7377 or complete the appointment request form below. We will then contact you within one business day to confirm your appointment.

If this is an emergency, or if you are trying to cancel or change an existing appointment, please do not use this form. Contact us by phone at 973-473-7377.

Refer Our Office

The form below will send an email to your friend. We will only contact them if they respond saying that they would like more information about our office.