Patient Forms

Please help us be prepared for your first appointment by completing this Patient Information and Medical History form. Download the form below (in either Word DOC or Acrobat PDF format) to your computer, print it out, complete the form, and bring it with you to your first appointment.

Patient Form

If you’re unable to read PDF files, you can download Acrobat Reader free from Adobe at:

http://get.adobe.com/reader/

For SMILES CHANGE LIVES PROGRAM visit:

http://www.smileschangelives.org/qualify