New Patient Forms

Please fill out our forms electronically online:  

Or, you may print your forms, fill them out, scan/email ([email protected]),  fax (573-446-3685), or bring them with you 15 minutes before your first appointment.  Just click on the links below:  (If you are unable to complete your forms before your appointment, please arrive 30 MINUTES before your scheduled time to fill out the necessary forms in our office.)

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

This link includes:

  • 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)

This link includes:

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

Records Transfer Request Form 

What You Should Know About Dental Insurance


"Dental Health and Happiness since 1992"

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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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