Patient Forms

Please print one of these forms, fill it out and bring it to your first appointment.
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
emergency_patient.pdf
File Size: 170 kb
File Type: pdf
Download File
For Teledentistry appointments, please also review our HIPAA Privacy Form, then print out and sign the first and last pages to send to us.
Email:  info@flemingsburgdentist.com
​Fax:  888-724-9594
hipaa_privacy_practices-2020_version.pdf
File Size: 104 kb
File Type: pdf
Download File