1720 Destiny Lane Bowling Green, KY 42104
270-842-3554
PATIENT INFORMATION
Save time at the office and fill out your patient information paperwork ahead of time.
ABOUT YOUR VISIT
Preparation for your appointment
Your comfort and the experience you have at our office is important to us. To help make your check-in process faster and more efficient, please print and fill out the forms below that apply to you.
If you are a new patient, you'll see initial health history, patient information, consent for treatment, and a dental history form below. If you are a returning patient, please use the updated health history form to provide us the most recent information for you. Additional forms can be found if you would like us to provide your information to a third party, or if you would like to assign insurance benefits using our optional forms. Give us a call if you have any questions and we'll be glad to help you prepare for your appointment.
ADULT NEW PATIENT
INFORMATION
Please complete the forms below for all adult patients (18 and over)
Our office will accept assignment of benefits from your insurance company. To initiate, please use the form above
CHILD NEW PATIENT INFORMATION
HYGIENE
PATIENTS
Please complete the forms below for all children(17 and under)
Our office will accept assignment of benefits from your insurance company. To initiate, please use the form above
If you have visited our office before, please fill out the forms below so we know your most recent information.