Brockport Smiles

Complete our patient forms online prior to your visit. Please follow the instructions to fill out your form and your information will be sent directly to our office safely and securely. Prior to filling out your form, please read our Notice of Privacy Practices.

Patient Information Form
Dental & Medical History

New Patients Welcome

Meet Your Smile Makers

Experience another level of dentistry with a fresh approach to dental care at Brockport Smiles. See why our patients travel from all across the area to visit us, including Batavia, Holley, Spencerport, Albion, Greece, Hamlin and Hilton.

Meet Your Dentists
Dr. Maxwell Thaney, DDS and Dr. Andriana Shumova, DMD
Dr. Maxwell Thaney, DDS and Dr. Andriana Shumova, DMD

Contact Us

We are here for you. If you need any help completing the forms or just want to ask a questions, please feel free to connect with us.


We want to help you receive the maximum insurance benefit for your dental care. We work with most dental insurance and will submit your dental insurance claims on your behalf. 

First Visit »

Payment Options

You are important to us and so is your oral health. We will develop a treatment plan to work within your needs and budget. We also offer payment plans and financing options.

View Payment Options »

Schedule An Appointment

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