New patient resources
Thanks for choosing us as your child’s dental home
We can’t wait to meet you and your child. Here’s a roundup of all the essential information you need to know about becoming a patient. Keep scrolling to access forms, learn about payment and insurance options, and get a sneak peek of our kid-friendly office.


Onboarding forms & disclosures
We’ve made all our essential forms and information available online so you can complete them in advance. Need help determining which forms to complete? Call us at 317-846-5893.
Required new patient forms
New patient packet: We use the basic information you share when completing this packet to provide your child with personalized care.
- Demographics form
- Insurance and financial form
- Medical history form
- Dental history form
- HIPAA privacy authorization form
Additional forms
- Communication & sensory questionnaire: This form lets you share your child’s unique communication methods and preferences, helping us tailor their visit for maximum comfort.
- Tongue-tie form: If diagnosed with a tongue-tie, we use this form to assess the severity of a child’s frenum in restricting movement to make informed treatment recommendations.
Important information
- Notice of privacy practices: Learn how we protect your family’s personal information and your rights regarding that information.

Refer a patient
Hamilton County Pediatric Dentistry provides stress-free kids’ dental services to all children, including those with special needs. If you need to refer a patient to our practice, please complete and return our patient referral form via email or fax.
Tour our office
Hamilton County Pediatric Dentistry’s warm and friendly office is designed with your child’s comfort in mind. From the colorful décor to the kid-friendly amenities, we strive to make every visit a positive experience.
Convenient and flexible
Billing & insurance
Payment options at Hamilton County Pediatric Dentistry include:
- Cash
- Check (restrictions apply)
- Credit card (we accept Visa, MasterCard, Discover & American Express)
- In-office financing (for established patients)
24/7 online bill pay
We accept payment online through our secure portal. Click the button to get started.
Hamilton County Pediatric Dentistry is a fee-based provider and accepts all insurance plans. Dr. Laura Juntgen and our team will see any patient, regardless of their family’s insurance status.
We’re an in-network provider for Delta Dental only. If you have insurance from another group, they may cover part of your out-of-network bill, but your family will be responsible for the remainder.
Payment options at Hamilton County Pediatric Dentistry include:
- Cash
- Check (restrictions apply)
- Credit card (we accept Visa, MasterCard, Discover & American Express)
- In-office financing (for established patients)
24/7 online bill pay
We accept payment online through our secure portal. Click the button to get started.
Hamilton County Pediatric Dentistry is a fee-based provider and accepts all insurance plans. Dr. Laura Juntgen and our team will see any patient, regardless of their family’s insurance status.
We’re an in-network provider for Delta Dental only. If you have insurance from another group, they may cover part of your out-of-network bill, but your family will be responsible for the remainder.