: This form contains all of your basic personal and insurance plan information, which will help us streamline your benefits and customize your care.
: Your dental history tells us everything we need to know about your past experience, sensitivity, and current concerns.
: Your medical history is unique to you. Understanding your needs will help us provide a personalized, comfortable visit – every time.
: We are happy to help you maximize your dental benefits, if you have them. Please read, sign and return this form.
: Our team is passionate about ending cavities. This form helps us start the process.