Dr. Todd R. Levine and his associates at Aspire® Family Dental have a very diverse and extensive amount of training in all aspects of general dentistry. Collectively, they have many years of experience which makes this is a very unique general dental practice. All phases of dentistry are offered here. We have the most advanced technology that dentistry has to offer! In this office, modern dentistry is the rule, not the exception.
There is a lot of very useful information in this New Patient Document. PLEASE take the time to read everything! Dr. Levine believes in making sure all patients are informed to the fullest extent. In order to make it easier for those who would like to electronically submit the New Patient Form online; the entire Document was split into 2 Separate Sections. The First Section (pg. 1-7) is more information based. Dr. Levine would like you to know about many of the fantastic benefits of being a patient at this very modern office. The entire staff is very confident that you will find this practice to be the most unique that you will ever see! The Second Section (pgs. 8-12) contains the New Patient Form which can be electronically submitted.
Since we are screening for conditions that may actually save your life or contribute to failure in your dental treatment, we have included screening questions for Obstructive Sleep Apnea (OSA) and Temporomandibular Disorder (TMD). For patients who have been referred here from other dental or medical offices or are experiencing symptoms related to OSA and/or TMD, we have either included more specialized forms (or you can click on the below links to either fill them out electronically or print them). We want your treatment to be very successful and have the best overall health! We know everyone hates filling out forms. However, PLEASE take your time and answer the questions as best you can. The answers you provide can help us potentially greatly improve your chances of a successful outcome with your overall dental treatment and may even help us save your life!
To read about our Advantages of Being a Patient at Our Office, OFFICE POLICIES/CONTRACT, and Notice of Privacy Practices & Combined Signature Page (Your Copy) which is referenced in the New Patient Packet below click here.
To fill out our New Patient Packet please click here.
Once you have submitted your form, one of our receptionist will call you to schedule an appointment. You can feel free print the form and then call us first for an appointment if you would like (716-284-0110). Thank You!
Additional Forms or links
For Patients with Jaw (TMD) related issues:
Read more about Temporomandibular Disorder (TMD/TMJ).
TMD/TMJ referrals and consultations will be seen by Dr. Todd R. Levine at his office which is located at 5862 Snyder Drive, Lockport, NY 14094. You will be directed to see our webpage for Temporomandibular Disorder (TMD/TMJ) information and to fill out our specialized Questionnaire.
- Pain or tenderness in the face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
- Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth (which may or may not be accompanied by pain) or chewing
- Clenching or grinding
- Difficulty chewing or a sudden uncomfortable bite – as if the upper and lower teeth are not fitting together properly and/or teeth with wear marks on them
- Restorations prematurely failing
- Limited ability to open the mouth very wide
- Jaws that get “stuck” or “lock” in the open- or closed-mouth position
- Swelling on the side of the face
- A tired feeling in the face
- Other common symptoms of TMD include toothaches, headaches, dizziness, hearing problems, and ringing in the ears (tinnitis).
Please fill out our TMD/TMJ Questionnaire. (Lockport Location Only)
For Patients with Obstructive Sleep Apnea (OSA) related issues:
If you are being referred here from another dental or medical office OR if you are experiencing any of the below symptoms, then click HERE.
- Excessive daytime sleepiness, impaired cognition, mood disorders and/or insomnia
- Have headaches and/or fall asleep easily when you have down time
- Do you constantly feel fatigued and worn down?
- Are you overweight and/or have a large neck?
- Do you snore a lot or even loud where it wakes your partner up at night?
- Do you previously have a CPAP machine and hate wearing it?
Please fill out our OSA form for this office.