Practice Name

Specialty

City, State

Phone

Patient Information

First Visit

Please assist us at the time of your initial visit to the office by providing the following information:

  • Your referral slip and x-rays from your referring dentist. 
  • A list of medications you are currently taking (please note that you can fill out your patient registration and medical history form on our website.) 
  • If you have dental insurance, please bring any forms or insurance cards with you to the appointment. 

Please Note: All patients under 18 must be accompanied by a parent or guardian at the consultation appointment.

Please notify the office if you have a medical condition or concern prior to surgery (e.g. artificial heart valves or joints, heart murmurs requiring pre-medication, severe diabetes, or hypertension).

We will complete an in-depth medical and dental health history and a thorough examination to measure for bone loss, loose teeth, bite, oral cancer screening, TMJ, and other signs of periodontal disease.