Patient Forms

Call (330) 725-2242

If you are a new patient to our office, below you will find our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Patient Information
Medical History
Privacy Policy
Informed Consent for Virtual Services Form
COVID-19 Pandemic Emergency Dental Treatment Consent Form

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

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We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

Smile With Confidence

As dental professionals it is our priority to provide quality dental care you can trust.

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