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Membership Savings Plan

Patient Forms

patient forms

Download Patient Forms

A little bit of time now, will save you a lot later. Please download, fill out the appropriate form below and bring it with you to your appointment. We look forward to seeing you!

We’re always happy to answer any questions you may have regarding your patient form—just call, write, or ask your dentist.

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Protect your families dental health

A Membership Savings Plan is an alternative option to get greater access to routine dental care for families that do not have dental insurance. This plan is designed to provide affordable care and cover expenses for regular check-ups, cleanings, and other basic dental services.

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Dr. Laura Lan

Dr. Laura will be in our office over the next couple of months. Dr. Laura Lan grew up in Los Angeles, California. She obtained her Bachelor of Science degree from the University of California, Davis. Dr. Laura made her way out to the Midwest to attend The Ohio State University College of Dentistry, where she earned her Doctor of Dental Surgery degree.

In her free time, Dr. Laura enjoys spending time with family and friends, hiking, and practicing yoga.

FUN FACT… Laura was a classmate of Dr. Rachel’s at Ohio State, and while Fara is a year ahead of Laura and Rachel, she is a close friend of Fara’s from dental school.

Steve M. Jones, D.D.S.

Senior Dentist Emeritus

Dr. Steven M. Jones is a graduate of Shawnee High School. He attended Miami University in Oxford, Ohio where he received his B.A. in Microbiology in 1986. Four years later he received his Doctor of Dental Surgery Degree (D.D.S.) from the Ohio State University College of Dentistry. Dr. Jones entered private practice in 1990 in Columbus, Ohio. Dr. Jones also practiced in one of the first after hours dental emergency clinics in the country. After several years of private practice, he returned to his hometown of Lima, Ohio. Dr. Jones served as a clinical instructor at the Lima Technical College Dental Hygiene School and began planning a new general practice in the Lima area. In 2002 Dr. Jones opened the newly constructed Northwest Dental Center. Dr. Jones is a member of the Ohio Dental Association, American Dental Association, Northwestern Ohio Dental Society & Academy of Contemporary Dentistry in Columbus Ohio.

Dr. Rachel Salen, D.D.S.

Dr. Rachel Salen grew up in Erie, Pennsylvania until her family moved to Quincy, Illinois where she graduated from Quincy Notre Dame high school.

She then crossed the Mississippi River to study at Saint Louis University where she earned her Bachelor of Science in Biology and Bachelor of Arts in Classical Humanities. Her family then moved to her father’s hometown of Warren, Ohio, leading her to choose The Ohio State University College of Dentistry for her post-graduate education where she would go on to earn her Doctorate of Dental Surgery.

Dr. Salen is very excited to begin her career serving the great people of West Central Ohio.

Dr. Salen will make a great addition to our patient-centered team by providing comprehensive care for patients of all ages, including operative, prosthodontic, endodontic, and surgical treatments.

In addition to delivering great dental care, Rachel enjoys taking too many pictures of her cat, traveling across the Midwest and Northeast to visit her family and friends, and reading a good book!

Fara Hurt, D.D.S.

Dr. Fara Hurt grew up in Lima, Ohio. She is a graduate of Elida High school.

Dr. Hurt earned a Bachelor of Science in Dental Hygiene and Doctor of Dental Surgery degree from the Ohio State University College of Dentistry. Fara worked for several years in the Columbus area, helping patients with their oral health needs and supporting patients with their periodontal care.

As a dentist, Dr. Hurt will make a great addition to our patient-centered team by providing comprehensive care for patients of all ages, including operative, prosthodontic and endodontic treatments In addition to delivering great care, Fara enjoys spending time with family and friends. She also enjoys hiking, traveling, and attending football games.

Mary Wiechart, D.M.D

Dr. Mary Wiechart is a Lima native. She is a graduate of Lima Central Catholic High School. Dr. Wiechart earned a Bachelor of Science in Nature Sciences from Xavier University. She earned a Doctorate of Medicine from the University of Kentucky College of Dentistry.

Her practice includes operative, prosthodontic, endodontic and surgical treatments. In addition to delivering great care, Mary enjoys spending time with family, friends and her dog, Bella. She also enjoys baking, golfing, traveling and listening to music.

Jill A. Miller, D.D.S

Senior Dentist

Dr. Jill A Miller is an Elida native and Elida High School graduate.

She is a graduate of Ohio Northern University and earned her Doctor of Dental Surgery degree from The Ohio State University in 2009.

Dr. Miller provides comprehensive care to patients of all ages and strives to make patients feel comfortable. Her goal is to make going to the dentist a pleasant experience for children and adults.

Dr. Miller has served as externship site host for Ohio Northern University and has partnered with the University of Northwestern Ohio to provide emergency dental care to student athletes.

Dr. Miller is a member of the Ohio Dental Association, American Dental Association, Northwestern Ohio Dental Society, and the Ohio State University Dental alumni society.

In her spare time, Dr. Miller volunteers in the children ministry at her church, enjoys running and spending time with her husband, Zac, and their 3 children.