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Download patient forms and learn about your first visit with the dentist.

Andrea is serious about her dental health.First Visit

We welcome you to our dental center in South Bend, Indiana and look forward to participating in your dental health. Your first visit at Jefferson Dental Center will consist of a comprehensive oral evaluation that will require a full mouth series of dental radiographs. We prefer to use digital dental technology to provide Dr. Celis with crisp high resolution radiographs of her patients but will gladly accept recent radiographs on film, photo-paper or digital format from another office.

On your first visit, there are a number of required new patient forms that will need to be completed. These new patient forms include a patient demographic sheet, consent form, financial and a medical history. We are also required by law to advise you of our Privacy Policy in regards to your private health records and to obtain signatures of all patients, and or guardians, to disclose and use your private health information with other health professional in the treatment of your dental health.

More information on our Privacy Policy regarding PHI can be found here. It is the office's policy to require a government issued ID to create an account. Please bring all insurance cards issued from employers and your ID card to your first appointment.

After your information and medical history has been recorded in your digital record, we will start with taking radiographs and an initial assessment by a hygienist or an assistant of the dentist. Dr. Celis will complete a comprehensive oral exam which will aid in creating your treatment plan. Our dentist will prescribe what type of cleaning regime and explain in detail any conditions you may have or experience.

Treatment plans can be created to offer the patient multiple choices on the way their treatment is approached. Dr. Celis will take the time to explain the different approaches to maintaining or restoring your dental health. Having a digital treatment plan recorded on the first appointment allows you to know a good estimation on how much your treatment will cost with or without dental insurance.

We are contracted and in network with a number of dental insurances as well being able to submit electronically to hundreds of dental insurance companies offered through employers and single plans.

We are in-network with:

Traditional Insurances we submit electronically to:

  • Aflac
  • Ameritus
  • Blue Cross Blue Shield
  • Cigna
  • Guardian
  • Lincoln Financial
  • MetLife
  • Meritain
  • United Healthcare
  • United Concordia (military)

Have a different insurance? Call us at (574) 233-7266.


Want to get in touch?

You can contact the dental team at Jefferson Dental Center using the contact form on this site. You can request account information or leave a testamonial.

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