New Patient Forms

Accepting New Patients 

You’ll be reassured to know that we care for our patients. What makes Dr. Santilli one of the top family dentists in Columbus, Ohio is our combination of state-of-the-art dental technology, such as laser dentistry tools, digital x-rays, and a computer-assisted tomography panoramic scanner, with personal experience and skill. Call our office to schedule your new patient visit today! 614-837-7770

Please click the link to complete the patient forms online:

For your convenience you can or click to download the PDF forms to print and bring in.  Completing the online forms will make it faster and easier upon your arrival.

NO insurance? NO problem!

We are now offering an in-house dental plan to help make dental care more affordable for patients without insurance coverage. For a yearly fee, the appropriate care plan package includes:

  • preventative dental cleanings
  • exams
  • oral cancer screenings
  • radiographs

Each package is designed to help you meet your preventative dental care needs each year, but also includes additional savings on restorative treatment needs, such as crowns, fillings and cosmetic services. Package prices are as follows:

Adult Heathy Services Package: $340

(Minimum savings of $145)

Child Services (12 and under) Package: $290

(Minimum savings of $155)

Adult Periodontal Services Package: $440

(Minimum savings of $135)


For more details about each package and eligibility please contact our office today!





Contact us to Make an Appointment

Diley Ridge Dental is conveniently located to serve Canal Winchester, Pickerington, Groveport, Lancaster, and their surrounding communities.