New Patient Form

We are excited about meeting you!  Please assist us by providing the following information at the time of your first visit:

  • Any panoramic X-ray taken within the past six months.
  • If you have orthodontic insurance, bring your insurance card. By providing this information at the first visit, we will be able to give you an estimate of your benefits.

Please complete the following patient form to assist us with your care and submit it to us prior to your first visit. This will eliminate the need for you to bring this information with you and it will enable us to research your dental insurance benefits in advance.