New Patient Forms

Please fill out our forms electronically online:  Click Here

Or, you may print our forms, fill them out, scan/email ([email protected]),  fax (573-446-3685), or bring them with you to your first appointment.  Just click on the links below:

New Patient Forms – Age 17 and Under (7 Pages)

  • Information Form – 17 and Under
  • Acquaintance Form – 17 and Under
  • Health History  HIPAA
  • Notice of Privacy Practices (2 pages)
  • HIPAA Acknowledgement Form  Signature Sheet 

New Patient Forms – Age 18+ (7 Pages)

  • Information Form – 18+
  • Acquaintance Form – 18+
  • Health History 
  • HIPAA
  • Notice of Privacy Practices (2 pages) 
  • HIPAA Acknowledgement Form  Signature Sheet 

What You Should Know About Dental Insurance

Records Transfer Request Form 

"Dental Health and Happiness since 1992"

Contact Us

We will respond by our next business day. You may prefer to call us at (573) 446-2687. Please leave a message if you reach our voicemail. Thank you!

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