Patient Forms

What to know for your appointment: 

We ask that everyone continue to wear a face mask coming into either of our offices.

The assistancs will let you know when you can remove it and when you need to put it back on.

  • Don't arrive early and no more than 15 mins late to your appointment or we may have to reschedule you! Only patients will be allowed to come in unless we have told you a parent can come in. This is to decrease the numbers of people in the office at any given time. 
  • When you come in, we will ask a few questions, do a quick temperature check. (Must be below 100 to continue with your appointment), give you some hand sanitizer then go to your assigned dental chair.
  • After your parent/companion should call so we can make your next appt.
  • Payments, can be made in several ways:
  • when you set up your appointment,
  •  at the time of your appointment, you can have the patient bring it up
  • drop an envelope in our mail slot
  • call us on our main number, while you are in parking lot and we will get credit card information.


COVID-19 Screening Form

Our patients' safety is our hightest priority as we are trying to protect both our patient' health and our staff's.

NOTE: you will have to respond to these questions each time you come in!



COVID-19 Screening Form

1. Have you yourself or someone you've come in contact with had symptoms or tested postive for COVID within the past 14 days?

  • I​F YES...
    • ​I'm sorry we are going to have to reschedule your appointment.

​​​2. In the last 14 days, have you had or are you having any symptoms such as fever, sore throat, cough, muscle aches, extreme fatigue, nauseousness, vomiting, GI upset or loss of taste or smell?

  • IF YES...
    • Which symptoms?
    • How long did the last?

We can’t thank you enough for your patience and understanding as we all work through this, together!

Thank You Again!


Online Patient Forms


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