Flemingsburg Dental Care
  • Home
  • ABOUT US
    • Meet Dr. Moorhead
    • Meet the Team
    • Hours and Directions
    • Testimonials
  • Services
    • Same Day Services
    • Sedation Dentistry
    • Invisalign >
      • Invisalign Before and After Photos
    • Botox & Dermal Fillers >
      • Botox Before and After Photos
    • Denture Services >
      • Advanced Denture Technique
      • "Whole You" Dentures
      • Lock Tight Dentures
    • Dental Resource Library
  • Special Offers
    • Special Offers
    • Dental Value Plan
  • Patients
    • Patient Forms
    • Insurance Participation
    • Financial >
      • Dental Value Plan
      • Financial Arrangements
      • Online Payments
      • Dental Financing >
        • Patient Financing
        • CareCredit
        • Prosper
    • Anti-Discrimination Notice
    • Privacy Practices
    • Website Accessibility
  • Contact
    • Contact our Office
    • Join Our Team
    • Dentist referrals
    • Hours and Directions

Patient Forms

Picture
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
Download File

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
Download File

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

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

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

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.
emergency_patient.pdf
File Size: 170 kb
File Type: pdf
Download File

adult_new_patient_exam.pdf
File Size: 204 kb
File Type: pdf
Download File

child_new_patient_exam.pdf
File Size: 123 kb
File Type: pdf
Download File

free_dental_day.pdf
File Size: 53 kb
File Type: pdf
Download File

Phone

888-733-3163
OR

Use the contact form to e-mail us 

Stay in touch:

Hours:

Monday- Friday:  7am - 7pm
and Saturdays!

  • Home
  • ABOUT US
    • Meet Dr. Moorhead
    • Meet the Team
    • Hours and Directions
    • Testimonials
  • Services
    • Same Day Services
    • Sedation Dentistry
    • Invisalign >
      • Invisalign Before and After Photos
    • Botox & Dermal Fillers >
      • Botox Before and After Photos
    • Denture Services >
      • Advanced Denture Technique
      • "Whole You" Dentures
      • Lock Tight Dentures
    • Dental Resource Library
  • Special Offers
    • Special Offers
    • Dental Value Plan
  • Patients
    • Patient Forms
    • Insurance Participation
    • Financial >
      • Dental Value Plan
      • Financial Arrangements
      • Online Payments
      • Dental Financing >
        • Patient Financing
        • CareCredit
        • Prosper
    • Anti-Discrimination Notice
    • Privacy Practices
    • Website Accessibility
  • Contact
    • Contact our Office
    • Join Our Team
    • Dentist referrals
    • Hours and Directions