Financial Options

At the office of Dr. Blaine Cusack, we are dedicated to bringing you quality dental care while also accommodating your financial situation. To learn about the insurance providers that we are in network with, please call or visit our office. To meet your needs, we also accept the following forms of payment:


  • Visa
  • MasterCard
  • Discover
  • Cash
  • Check
  • CareCredit


CareCredit, a third-party financing company, offers low- and no-interest payment plans. For more information and to apply before your visit to our dental office, please visit their website. As always, we welcome you to call our office if you have any questions regarding your financial options or to schedule an appointment with our experienced dentist. We look forward to hearing from you soon!

Care Credit

Patient Forms

We invite you to prepare for your visit with Dr. Blaine Cusack by printing and filling out our patient forms. Bring them with you to your appointment at our dental office to save some time and to streamline your experience. You can also fill out and submit the forms online! Please call or visit our dental office if you have any questions; our friendly and knowledgeable staff members are always here to take your calls, answer your questions, and schedule your consultation with our experienced dentist in Countryside, Illinois!

New Patient Forms

Head, Neck, Face Questionnaire

Orthodontic Questionnaire

Sleep History Questionnaire