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Welcome to Your Best Smile
Family Dental Staff, Chemung Family Dental, Elmira NY

New Patient Information & FAQs

Congratulations on joining the Chemung Family Dental family! We look forward to seeing you during your visit to our office in Elmira, NY. To ensure an efficient, productive appointment, please review the information on this page. Call us at 607-734-2045 with any questions.

NEW Fillable Patient Forms


*Computer Users:
Download & Open PDFs in Acrobat (Get Acrobat Here)
**Mobile Users:
1. Download Adobe Acrobat Reader app. (App Store | Google Play)
2. Import to Acrobat
3. Fill & Sign

▪ Children’s Medical Health History Form
▪ Medical Health History Form
▪ Medical Health History Update Form

Please download, print, and complete the applicable forms below and bring them with you to your appointment:

▪ Soft Tissue Management Update Form
▪ Whitening for Life Form
HIPAA Notice (Coming Soon)

Insurance and Payment

We will submit your insurance forms for you to maximize your coverage and benefits.

We do not accept Medicaid/Fidelis, or Children’s Health Plus insurances.

Full payment is expected at the time services are rendered. We accept cash, check, and all major credit cards.

We offer Lending Club Patient Solutions for flexible payment plans with no money down. Ask us for more information.

Do you accept Medicaid?

No, we do not accept Medicaid.

Do you accept my insurance?

We submit claims to your insurance company. Medical insurance is billed & accepted for Sleep Apnea treatment. We do accept Medicare for this treatment. Contact us to find out what we can do for you.

How much is an initial consultation?

We offer free consultations for new patients. X-rays are not included.

Do you offer financing options?

We use Lending Club Patient Solutions for low interest, low monthly payment financing. Visit the website to apply.

Can I see some of the work you’ve done?

Of course! See our Before & After gallery here.

Chemung Family Dental
1007 Broadway St.
Elmira, NY 14904

Monday 7:00 AM - 4:00 PM
Tuesday 7:00 AM - 4:00 PM
Wednesday 7:00 AM - 4:00 PM
Thursday 7:00 AM - 2:00 PM
Friday Closed
Saturday Closed
Sunday Closed


Please be aware for the safety of our patients and the public as well as our Dental Team we are following all CDC, ADA, OSHA & NYS Health Department Guidelines. In addition to required PPE (gowns, gloves, appropriate masks and face shields) we also have air purification and filtration machines throughout the office and in all treatment rooms. These units remove harmful bacteria and viruses of all types, mold and pollens. These additional steps have been taken to ensure your safety, comfort and peace of mind. Please call our office with any questions you may have. Thank you.