Drake Dental
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KALAMAZOO
269-344-7222

PORTAGE
269-488-8400

PAY ONLINE
  • Our Team
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      • Teeth Whitening
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      • Veneers
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Patient Forms

If you are a new patient, you are welcome to fill out your new patient paperwork online with our secure forms:

Online Patient Forms


If you would rather print and fill out the forms, please open and save each of the forms below and bring them to your appointment:

Patient Registration

Medical History

Dental History

Financial Policy

Privacy Practices / Records Release

COVID-19 Screening


If you are an existing patient and we have requested that you fill out our COVID-19 Screening form, please fill out and submit this form:

COVID-19 Screening


If we have requested that you fill out our Medical History form only, please fill out and submit this form:

Medical History


If we have requested that you fill out any of these additional forms, please fill out the requested form:

Consent for Pediatric Treatment

Medical Clearance for Pregnant Patients

Authorization for Release of Information


If you would like to submit an online request for us to release your records to another healthcare professional or individual, please fill out and submit this form:

Records Release

We look forward to meeting you!

Contact Us

TWO LOCATIONS

Kalamazoo Location

Portage Location

465 South Drake Road
Kalamazoo, MI 49009
269-344-7222
Monday: Closed
Tues-Fri: 8 am to 5pm

1801 West Centre Avenue
Portage, MI 49024
269-488-8400
Mon-Thurs: 8 am to 5pm
Friday: Closed

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Kalamazoo Office


Portage Office


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