Dental Care by Design - New Patient Forms

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We are happy you have decided to become a patient and we are looking forward to seeing you! In order for you to have a quicker, more enjoyable visit to the dentist, please print and fill out the four forms below. Adobe Acrobat is required to view the forms. Please click here if your computer does not have Adobe Acrobat.

Fill Out the Following:

Confidential Medical History Form

Confidential Patient Information Form

Office Privacy Policy Acknowledgment Form

Office Payment and Cancellation Policies

Send us Your Completed Forms:

If you'd like to send us your forms electronically (in lieu of printing them), please fill out the four .PDF files listed above and save them to your computer. Once you have filled them out and they are complete, save the changes. After your changes have been made, click browse next to each box below, choose one of the completed files for each box and click "Upload". Please contact us if you have any questions.

Select file 1

Select file 2

Select file 3

Select file 4

Under what patient name should we file these?

Please make sure you save any changes you've made before continuing.