Patient Forms, Map and Directions to Plainfield Office

Your first visit to Heritage Grove Family Dental establishes a vital foundation for our relationship with you.  During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You’ll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There’s also background information about our committed staff and our first visit procedures. You can even save some time at your first visit by printing out and completing the patient forms in advance of your appointment.

Mission Statement:

We strive on providing you with the best dental experiance possible.  Doctor Gallos has spent his career in preparation for your visit and treatment.  Our vision and dream is to provide you with the "Family Dentist" who can treat everyone in your family.

To fulfill this mission, we are committed to:

  • Listening to those we are privileged to serve.
  • Earn the trust and respect of patients, profession and community.
  • Exceed your expectations.
  • Ensure a creative, challenging and compassionate professional environment.
  • Strive for continuous improvement at all levels.


Patient Forms
Please print and fill out these forms so we can expedite your first visit:

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.



Insurance and Billing
Our practice accepts most traditional insurance plans and we are an in-network provider with most major PPO insurances.  We  have provided a list below with some of the major carriers.  If you don't see your insurance carriers name on the list please call the office to verify if we accept your insurance and/or are adding your insurance to our office.  Regretfully Heritage Grove Family Dental does not participate in any (HMO, DMO) insurance plans.  We will be happy to file insurance for your reimbursement as long as you are free to choose your own dentist.

We offer several options to allow your dental treatment to fit your personal budget.  For your convenience we accept the following forms of payment: cash, personal checks, credit cards, and Care Credit.  We also offer a flexible payment plan.

  • Aetna                                       Ameritas                                 Assurant
  • BCBS                                       Cigna                                      Connection Dental
  • Dearborn National                  Delta Dental                           DHA Network
  • DNOA                                      Guardian                                GEHA
  • Human                                     Metlife                                    Principal
  • United Concordia                   United Healthcare                 Generous Senior discount


Driving Directions

  • Across from Heritage Grove Middle School