Dental Information


Click for more information on the dental treatment that’s right for you:

Enter a Patient Health History

Please read the information below before proceeding.

Thank you for selecting us to provide dental care for your family. So that we may better serve you, please complete this questionnaire. Clicking the “Proceed” button below will deliver you to our secure server. The forms are protected with 128-bit encryption and all submitted information is confidential.

Submitting Information for Multiple Patients: If you are submitting information for more than one person, please fill out a unique form for every new patient. Once you complete each form, click the “Submit Another Patient’s Information” button to start a new patient form with the same address, billing, and insurance information.

Alternatively
You May Download the Form

Click the button to print the form at home. Please bring the completed paper forms with you when you come for your visit. If you have trouble saving the pdf file you can right click on the button and save the file to your computer for completion at your convenience.