Your First Visit

Your First Visit

Our mission is to guide our patients along a path of optimal health and wellness for life; to non-judgmentally deliver the highest possible level of care, with empathy and understanding.

At your first visit, you will complete our Patient Information and Health History form. We request all new patients to arrive 10 minutes before their scheduled appointment to complete this form. To save time, you may also complete the form online below.

PATIENT INFORMATION AND HEALTH HISTORY

Patient's First Name

Patient's Last Name

Marital Status

Date of Birth

Patient's Address

Patient's Phone

Person Responsible for Account

Phone

Address

Employed by

Business Phone

Business Address

Dental Insurance Plan (if any)

Referred by