Patient Resources

(Click on a Clipboard Link Below for the Forms You Need)

For your convenience, we have grouped together the most commonly used forms and resources, below.  Simply select the type(s) of forms to complete by clicking on the applicable clipboard icon.  If you need assistance reading or understanding the forms, please contact our Linglestown Family Dental office in Harrisburg, PA, at 717-652-2700.

Linglestown Family Dental New Patient Forms

If you are a new patient who has not yet been seen at our office, please click on the “New Patient” clipboard link and complete/submit the patient information forms.  The forms will open in a new tab and be submitted securely to our office.  Thank you.

Linglestown Family Dental HIPAA Notice of Privacy Policy

We maintain a HIPAA (Health Insurance Portability and Accountability Act) compliant privacy policy.  Please click on the “HIPAA Notice of Privacy Practices” Clipboard to view, download and print our Privacy Policy.  The forms will open in a new tab and be submitted securely to our office.  Thank you.

Linglestown Family Dental Financial and Insurance Forms

To file your payment information or an insurance claim, please click on the “Financial and Insurance Info” Clipboard to learn about payment options and to enjoy discounted billing by joining the PDC Dental Membership Club.  Thank you.

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Contact  Us

Dr. Khal Syrianos-Robertson, DDS
4401 Linglestown Road
Harrisburg, PA  17112

Phone: 717-652-2700

Email:  Office@LinglestownFamilyDental.com

Office Hours

Monday: 8:00am – 5:00pm
Tuesday:
8:00am – 5:00pm
Wednesday:
8:00am – 5:00pm
Thursday:
8:00am – 5:00pm
Friday:
8:00am – 1:00pm