Become a Patient
The dental clinic is accepting new patients, please call 402.280.5990 to schedule an appointment.
Patient Application Form
We appreciate your interest in becoming a patient at the Creighton Dental Clinic. To apply, please review our patient resources and then fill out the confidential form below, which will be kept on file for no more than six months. We’ll get back to you as soon as possible. Please note that completing this form does not guarantee an appointment. Questions? Please give us a call at 402.280.5990.
Before Your Appointment
We’re dedicated to providing efficient, effective and comfortable care. We thank you for attending to the following before your appointment:
- Bring: A government-issued photo ID (or an equivalent–see Medical Identity Theft Policy) and your insurance or Medicaid card is required.
- Print: If able, print and complete the Patient Registration form in English or Español and bring it to your first appointment.
- Print: If able, print and complete the Health History form in English or Español and bring it to your first appointment.
- Patients under the age of 19, unless married or emancipated, need a parent or legal guardian present during the appointment to provide the required signatures.
- Review our patient resources to learn about your rights as a patient, the terms of your treatment and patient privacy.
- Unfortunately, we cannot provide day care for children or dependent adults. Please make appropriate arrangements.
We require a 24-hour notice for all cancellations. Please call 402.280.5990 to cancel your appointment. Treatment may be discontinued for patients who fail to keep appointments without prior notification, are consistently late or continue to excessively cancel appointments.
Creighton School of Dentistry provides a limited number of emergency appointments for patients who are experiencing acute dental problems.
- If you are patient of record and need assistance during the clinic’s hours of operation, please call 402.280.5990.
- If you are a patient of record and need assistance after hours, please call 402.280.5990 and request to speak to the dentist on call.
- If you are not a patient of record, please call 402.280.5990 and speak to our representative about the nature of your concerns. We will do our best to provide urgent care at the earliest possible time.