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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!

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

0% Interest Financing Options

We are happy to provide flexible financing options that work within your dental budget. Many of our patients choose zero percent or fixed-rate financing options to complete the treatment they need and enjoy the benefits of a beautiful, healthy smile for years to come.

There’s no risk and no hard credit check just to look at your available options with Green Sky Patient Solutions.

In addition to Green Sky Patient Solutions, we also accept payments through 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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Great experience! Loved the office and the music, too! I am very excited about getting my implants. Thanks, Dr. V!
Jimmy Crackcorn
Jimmy Crackcorn
22:25 19 Apr 17
Let me start by saying that I have not seen a dentist in a very long time and I have HUGE anxiety about dental work. Dr. Van de Vyver and his staff (especially his hygienist, Samantha) are amazing, simply put. They put me at ease with their lighthearted small-talk and let me see what they were doing with a hand mirror during my cleaning, which was so helpful. When I went back to have a wisdom tooth extracted they went above and beyond to make sure I was comfortable and at ease. My anxiety about dental work is non existent now and I'm so thankful he was able to work on me quickly, efficiently and with kindness. I would recommend him to anyone, no matter how far the drive. He's great!
Samantha Snyder
Samantha Snyder
14:05 16 Dec 16
I think I found my new best Dentist...
Clara Gothard
Clara Gothard
22:30 17 Nov 17
This was a visit for my 85 yr old mom. Everyone in the office was so pleasent and went out of there way for us. The fee is very reasonable. The entrance was not friendly for someone who can not walk well. The ramp is very far from the unmarked door to the office. We will certainly go back. I would become a patient if my insurance was excepted.
Vicki V
Vicki V
11:14 01 Aug 16
s d
s d
02:15 15 Jul 17
Fast and friendly and easy on a wimp like me! 🙂
Kim Doll
Kim Doll
17:29 19 Jul 18
Friendly staff and great experience! Keep up the phenomenal service! Always a pleasure. Quick and thorough.
Jacki Bretz
Jacki Bretz
20:53 31 Oct 18
Very good cleaning experience. Dr. V. did a great job at numbing my sensitive gum line.
Jeff Scheuer
Jeff Scheuer
15:42 07 Nov 18
Dr. Van de Vyver is new in the area, not dentistry. He is friendly and upbeat. Has all the latest technology, things I never seen before. He did a filling and crown (which he makes on site). Everything went smooth. I needed one of my wisdom teeth removed which he did yesterday. I wouldn't say I enjoyed it, but he did a nice job and I'm fine today (without pain pills). I had one done many years ago and was in pain for 5 days.
john griffin
john griffin
13:41 15 Nov 18
I was a new patient at this dentist office and went to get a filling replaced. The whole experience was quick, efficient, and absolutely pain free. I will be a returning customer.
Evan L
Evan L
17:07 11 Jan 19
Very professional, state-of-the-art, and above all, Dr. Van is a friendly, caring individual. I absolutely recommend him.
Bruce Barta
Bruce Barta
20:31 16 Jan 19
Dr. Van is one of the very best dentists that I have used and our family have used many dental practices. With many large practices you will spend the majority of your appointment with a hygienist or dental technician. Not with Dr. Van. You are getting all top-notch dentistry with the Dr. himself. He has a state of the art facility where you will enjoy beautiful fast dental procedures such as cleaning, laser cleaning, repairs, implants, whitening, devices for solving the dangerous health issue of sleep apnea and convenient dental implants. He also accommodates early morning appointments. Dr. Van is very knowledgeable about how to get the most of your dental insurance benefits and also set up an easy payment plan on our balance that we can manage with our monthly bills without breaking the bank. Dr. Van knows, loves and understands children and he is especially great as a pediatric dentist! Did I mention he wrote a book on modern dentistry, he did! See it in his office! Thanks Dr. Van and staff : )
Lisa Baca-Morse
Lisa Baca-Morse
13:21 13 Mar 19
I all of a sudden had pain in one tooth taking a drink of cold water one night. The next day I’m looking for a dentist because the pain didn’t go away and I come across this office and the reviews were all good so I called. They took me THAT day and both Crystal (the receptionist and assistant) and Dr. Van was so accommodating and nice I instantly got good vibes and felt comfortable. He was so gentle and you could tell he knew what he was doing. I ended up needing a root canal which he numbed me really good, didn’t feel a thing. He did a great job. I also got a cleaning and a full exam and again he was gentle. He actually talks to you and gets to know you. He has an awesome personality. You can just tell he cares and wants to get to know his patients. I just loved him. Crystal was SO patient and nice with all my questions (because I had A LOT) about pricing, payment plans, the procedure and appointments. They’re both so cool and down to earth and do such a good job, I HIGHLY recommend this office! Only thing is, they are only open 2 days a week. Which I did not know and felt bad because I called for 4 days with no call back and got a bit upset that I wasn’t hearing back from them, mostly because my husband was pestering me pretty bad about prices, procedures, etc. When Crystal called me back she explained to me their hours and went over everything with me, again with patience. We were on the phone a while because she took time to figure out how much everything would be and try to get me the lowest price. To me, that meant a lot. You don’t go to a lot of places that spend time trying to help you for that long and if you do the person gets an attitude or you can tell they’re annoyed but she wasn’t. Sorry this was so long. I just wanted to be detailed so you know this is a good place in every way! Love them.
Lori Lazar
Lori Lazar
18:02 01 Aug 19

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Copyright © 2019 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., a Michigan licensed general dentist. Shawn Van de Vyver, D.D.S. is not a board certified specialist 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.