Patient Forms

Patient Forms

Help Us Get to Know You

Please take a moment and fill out our patient information form. If you have any questions along the way, feel free to contact our practice.

Dental History Form

Medical History Form

Confidential Questionnaire

If you’re unable to open PDF files, you can get Adobe Reader® for free. Call us at (845) 209-2500 if you have any questions!

Aesthetic Family Dentistry

Office Hours

Monday - 8am to 6pm
Tuesday - 8am to 6pm
Wednesday - 9am to 6pm
Thursday - 8am to 6pm
Friday - 9am to 5pm

Phone Number

(845) 209-2500

Office Address

155 East Main Street
Port Jervis, NY 12771

Why We're Patient's First Choice

Our Values & Conveniences

Most Insurances Accepted

We work closely with many insurance companies to ensure your dental health. Give us a call today to find out how we can work with your insurance company.
Creating Beautiful, Healthy Smiles
Gentle, thorough examinations done by our award-winning team. Whatever your dental needs are - general or cosmetic - we make sure you get the best care possible.
Latest Technology
We are constantly updating our dental practices and equipment. Stop by and check out our latest upgrades, from our newly renovated office to our state-of-the-art sterilization center.
Convenient Appointments
Early morning, lunchtime, or late afternoon - whatever suits your schedule, we can accommodate. We know how important your time is, so we promise you little or no wait in our office.
Convenient Location
Centrally located in Port Jervis, NY and easily accessible from Orange County, NY, Pike County, PA and Sussex County, NJ.
Membership Plans
Don’t have insurance? Don’t worry, we have Membership Plans to help you afford to keep up with your dental health. Ask us about it today.

Contact Aesthetic Family Dentistry You can trust that our highly skilled staff at Aesthetic Family Dentistry will treat you with the highest standard in modern oral care.