3 Rivers Dental

Request an Appointment

Smile Today... Pay Later.

Please fill out the form below. Our staff will contact you soon to schedule an appointment. If you prefer to schedule an appointment over the phone call us Toll Free at 1.877.688.7533 or Greentree office at 412.921.2545, Greensburg office at 724.836.1777, or Jennerstown office at 814.629.6621. If you have dental insurance, the information below is necessary to obtain the details and benefits of your individual plan.

Fields marked with an asterisks (*) are required.

Patient Name *

Patient Birth Date

SSN *

Insurance Information

Dental Insurance Company *
Enter 'none' if you have no insurance.

Dental Insurance I.D Number *
Enter 'none' if you have no insurance.

Insurance Subscriber SSN *
Enter 'none' if you have no insurance.

Insurance Subscriber Name *
Enter 'none' if you have no insurance.

Contact Information

Primary Phone Number *

Type of Primary Phone:

Secondary Phone Number

Address 1 *

Address 2

City

State

Zip Code

Email *

May we contact you with a response, and future correspondence at this email address?

Preferred Appointment Date & Time

Date

Time of Day

Location *

Primary reason for visit / Additional Notes:

Download the Medical Health History report below. Complete the form on the right and bring it to your next appointment.

We accept most PPO's, Dental Insurance and Managed Care Plans. If you're looking for superior dental care for your family, look no further.

Need Emergency Dental Care? Call 1-877-688-7533 or call our Greentree office: 412-921-2545, Greensburg office: 724-836-177, Jennerstown office: 814-629-6621

We offer evening hours to fit your busy schedule:

Monday - 10am-6:30pm
Tuesday - 8am-4pm
Wednesday - 10am-6pm
Thursday - 9am-5pm
Friday - 9am-3pm