New Patient Forms

We can’t wait to see you!

In anticipation of your visit, we have a list of downloadable forms you can fill out at home and bring to your visit. This will help us ensure your visit is prompt and all of the necessary paperwork is taken care of, so all you have to do is relax.

To download a form, just click on the name of the form. It will open into a .pdf document that you can print out, fill out manually, then bring in with you before your visit.


Arrival Form
Dental History Form (For child patients)
Parent Consent Form
Patient History Form (For Adult Patients)
Patient Confidentiality Form
Protected Health Info Form

If you have a question or would like to speak to a member of our staff, please feel free to give us a call at 812-379-9561


Payment is expected at the time of service.  If you have insurance, we will be happy to file the forms for you.  However, we do ask that you pay your deductible and co-payment at the time of service.

We realize that the cost of dental treatment can be substantial at times. If you are interested in setting up interest-free payment plans for up to a year, please ask about it prior to scheduling an appointment or contact us by phone today.