New Patient Forms

We have made our New Patient Forms available on our Website for your convenience.


  1. Print first 3 forms below
  2. Complete the information
  3. Bring them with you to your appointment

The forms are available as PDF files. Please click the links below to view and print the forms. If you are unable to view or print either version, call us (1-888-Smile-10) and we can send you the forms in the mail, or you can plan to arrive early to your appointment and fill them out at that time.

Links to forms:

Request an Appointment

Our Patient Promise

  • 5 minute or less wait-time
  • Same-day new and emergency appointments
  • Insurance benefit analysis
Learn More
Interest-Free Financing - Up to 24 Months *when qualified