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New Patient Forms and Required Paperwork

We are excited to welcome new patients to our office, and we do all we can to ensure your initial visit is a positive one. To aid in this effort, we have provided our patient forms online for your convenience. To use, simply fill out the forms below and click submit. They will then be sent straight to our office before your visit with Dr. Shawn Van de Vyver, our skilled dentist in Shelby Township, Michigan. For help with our patient forms, please contact our dental office today. We would love to assist you!

CLICK HERE to complete your forms online

Patient Medical History

Informed Consent

HIPAA Policy

HIPAA Acknowledgement

Appointment Policy

Financial Agreement

Financial Options

We understand that navigating your dental finances can be tricky, which is why our knowledgeable dental team stands ready and willing to help you with all your financial options. Our goal is to help you and your family receive the dental care you deserve while working with your individual financial situation and needs. To assist in this process, we currently accept many dental insurance plans, and we are providers with:

  • Aetna
  • Blue Cross / Blue Shield
  • Connection Dental
  • Delta Dental Premier
  • DenteMax
  • MetLife

For our patients without insurance, we accept cash, credit cards, and Lending Club, a third-party financing company. We also have in-house payment plans available. If you have questions about your dental finances, please do not hesitate to contact our dental office in Shelby Township, Michigan, today. Our team at Great Lakes Dentistry would be happy to help you in any way we can. Apply for patient financing at Lending Club.


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Copyright © 2017 Great Lakes Dentistry | Shelby Township, MI 48316 |  All rights reserved. DISCLAIMER: This website is intended for general informational purposes only. It is not intended to provide any dental or medical advice, nor provide any diagnosis of any kind. Contact your physician or dentist regarding your individual, specific conditions. Great Lakes Dentistry assumes no liability by providing this information and provides no guarantee or assurances pertaining to treatment, outcomes, or results described. All images used on this website are either free use images or copyright of Great Lakes Dentistry. Content may be used only with the expressed written consent of Great Lakes Dentistry and Shawn Van de Vyver, D.D.S.. All specialty services provided by Shawn Van de Vyver, D.D.S. and Raymond Kim, D.D.S., licensed general dentists. Shawn Van de Vyver, D.D.S. and Raymond Kim D.D.S. are not board certified specialists in oral surgery, periodontics or orthodontics. Pre-treatment evaluation required for all procedures. Not all patients qualify for advertised treatment. 6 Month Smiles is a registered trademark and is not a substitute for comprehensive orthodontics. Advertised treatment length is average and individual treatment times may vary.

Get Dr. V's Book FREE

Just your name and email gets you your very own copy of iSmile: Why I Love Modern Dentistry and You Should Too. Enjoy! Please email me personally with any questions you might have about how modern dentistry can give you the smile you deserve.

Great! It's on the way now! :-)