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KALAMAZOO
269-344-7222
PORTAGE
269-488-8400
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Our Team
Services
General Dentistry
Pediatric Dentistry
Sedation Dentistry
Cosmetic Dentistry
Teeth Whitening
Dental Bonding
Veneers
Orthodontics
Periodontal Treatment
Dental Implants
Crowns and Bridges
Tooth Extractions
Dental Emergencies
Our Technology
Patient Resources
Patient Forms
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Contact Us
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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
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!