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Richard Rosenthal, DMD, JD
A Practice Caring for Adults with Special Needs
(856) 772-0007
NEW PATIENT FORMS
New Patient Appointments
Schedule an appointment for a special needs patient with one of our experienced and caring providers, fill out the new patient documents attached below & send them to our office. Please note, we are currently only accepting Horizon and United Healthcare insurance.
Please send your forms to our office via email or fax.
F: (856) 545-3295
Scheduling New Patient: Our Services
We will need a copy of all important documents for the first appointment.
Insurance Card (Front & Back)
Medicare Card
Full Health History
Covid Vaccine Card
SS#
Current list of medications
Guardianship Papers
Scheduling New Patient: Welcome
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