Dental Professionals

New Patient Forms

We have made our new patient forms available to you as Adobe Acrobat files for your convenience. Of course, you can always come by the office and fill them out like everyone else, but then, you wouldn't be looking at this page right now if you were like everyone else.

"Everything is just great. My teeth stayed in even after all the beatings my wife gave me - that must be some cement! As far as I'm concerned you folks are the best. Thanks, Al"  (Read more patient comments here)

Adult Forms (NP form, Epworth, all HIPAA forms) Child Forms (NP form, all HIPAA forms) Cosmetic Chief Complaint (if you have any cosmetic concerns) Snoring and Sleep Apnea Forms (Use these in lieu of Adult Forms if you are seeing Dr. Smith for sleep-related issues)

Download Adobe Acrobat Reader Now

We gladly accept MasterCard, Visa, Discover and American Express

CareCredit is a flexible patient/client payment program, specifically designed for healthcare expenses, that makes it easier for you to get the treatment or procedures you want and need. CareCredit is ideal for co-payments, deductibles, treatment and procedures not covered by insurance, and can be used at over 35,000 practices nationwide.