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419-774-7529

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Playtime Dental
  • About Us
  • Services
    • Cleanings
    • Sealants
    • Fillings
    • Crowns
    • Braces
    • Extractions
    • Mouthguards and Nightguards
    • Sedation
  • New Patients
  • Blog
  • Contact Us
  • 419-774-7529
  • Request an Appointment
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Patient Forms

You can access, download, and print the new patient forms by clicking on the links below. We recommend filling the forms out before your appointment and bringing them with you to reduce wait time at your first appointment!

New Patient Forms

Patient Referral Form

Patient Authorization Form

Medical Consult Form

Notice of Privacy Practices

Release of Records

Continuing Care Policy

Rescheduling Policy

CareCredit® Financial Policy

CareCredit® Payment Options

Playtime Dental

1145 Aspira Ct.
Mansfield, OH 44906
Phone: 419-774-7529
Email: officemanager@playtimedental.com

  • Disclosures
  • Insurance
  • Patient Forms
  • Links
  • Blog
  • COVID-19 Protocols

Nondiscrimination Disclosure

Cockley’s Playtime Dental, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis or race, color, national origin, age, disability, or sex.

  • 419-774-7529
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