What You Will Need at Your First Visit

1.   Current insurance information including

  • Insurance company name
  • Address
  • Contact phone number
  • Group number
  • Subscriber I.D. (This may be the covered employee’s S.S. number or a randomly assigned number from the insurance company.
  • Spouse’s  S.S. number and DOB (if applicable)
  • A signed and completed original claim form if your employer requires a new one to be submitted every year.
2.    A list of current medications the patient is taking

3.    Any available x-rays taken at your previous dentist’s office.  This would also include x-rays taken at specialty offices such as Orthodontists, Oral Surgeons, and Periodontists.

4.    Please take any pre-medication if  previously recommended by physician.

We ask that you arrive ten minutes prior to your first appointment to allow time to complete any necessary forms.



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Stephen E. Bloom, D.D.S., Inc.
Ohio Center for Cosmetic Dentistry
Highland Medical Center | 850 Brainard Rd. | Highland Heights, Ohio 44143
Tel: (440) 460-5400 | Fax: (440) 460-5403

In this fast paced world, we frequently make snap judgements. Your smile says so much about you in so little time. Does it project the proper image? Can you benefit from dental implants, porcelain veneers, tooth bleaching, bonding, crowns, or several other esthetic dental procedures? An attractive smile can be your biggest asset. Let it show what a successful person you truly are or hope to be. We have been on the cutting edge of cosmetic dentistry since 1976. Let us help you to benefit from our expertise and vast experience.