Patient Forms

Please fill it out one of these forms and email or text it to us before your first appointment.

Instructions:

website_instructions_for_filling_out_online_forms.pdf
File Size:	170 kb
File Type:	pdf

Use this first set of forms if you have a Laptop or Desktop Computer, but no printer:

emergency_patient_-_no_printer_required.pdf
File Size:	515 kb
File Type:	pdf

adult_new_patient_-_no_printer_required.pdf
File Size:	469 kb
File Type:	pdf

child_new_patient_-_no_printer_required.pdf
File Size:	278 kb
File Type:	pdf

free_dental_day_-_no_printer_required.pdf
File Size:	86 kb
File Type:	pdf

Use this set of forms if:

You can print the forms from your computer, OR
You need to fill out the form on your phone.
To fill out on your phone, download the free app Adobe Fill & Sign, use the app to complete the form, then text it back to us at 606-244-0879.

Phone