Lincoln: (402) 466-9632 | York: (402) 362-4636

Patient Forms

*The links below take you to a secure website provided by our software vendor where you can enter and update your information.

New Patient

Below you will find the new patient questionnaire.  If you are coming to visit us for the first time you can save time by filling this out online before you come in.

New Patient Form

Returning Patients

If you are a returning patient you can click below to login and update your information.

Returning Patient Login

Payment Information

Sullivan Family Dentistry offers Care Credit to all patients for easy financing of your dental treatment expenses, subject to credit approval. Care Credit offers patients multiple payment options. Ask our helpful front desk staff for more details.

We will accept and submit ANY dental insurance, regardless of the carrier. Here are some of the major dental insurance companies that we are In-Network for (PPO):

  • Blue Cross Blue Shield
  • Delta Dental
  • Ameritas
  • Cigna
  • Met Life
  • Standard
  • Principal
  • Aetna
  • Assurant
  • United Concordia
  • United Healthcare
  • Medicaid 

We guarantee your privacy.
Your personal information is kept strictly confidential.