Patient Forms

Forms


If you are new to our practice, please follow the instructions below.


Please print all pages, complete all sections and bring it with you to your first appointment.  If there are any areas that you are not sure about, please leave it blank and we will review it with you. Please also print the next form below, Consent to Treatment and Privacy, and complete it as well.

Welcome to our practice! Looking forward to seeing you soon and having you as part of our Dentistry on Yorkville family.

New Patient & Medical History Form


 

 

Treatment Consent Forms


Invisalign Consent Form
Please print this form and sign where indicated. Please be sure to bring the completed form, along with any questions, to your next appointment.

ZOOM Whitening Consent Form
Please print this form and initial and sign where indicated. Be sure to have this form with you at your consultation appointment.

ZOOM Whitening Pre and Post Treatment Instructions
This form has the information regarding the procedures to follow prior to your ZOOM Whitening treatment, as well as the instructions for the 48 hours after.  Please print this form and keep it handy for reference.

I appreciate the swift effort at assisting me with my dental pain as well as the caring and concern to remove said tooth. So grateful for this care.
S

Sherri M.
Caring, gentle, careful, detailed. Amazing staff. What more could you want from a dentist????
H

Harrison D.
This place is as beautiful as they come. So professional and welcoming. I couldn’t see myself going anywhere else. I would recommend everyone to visit to look more Gorgeous!
J

Jocelyn P.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
Ready for your first appointment?