Online Forms


We want your first visit with us to be as relaxing as possible.   Please take a minute to print and fill out your New Patient Information, Health History Questionnaire and Informed Patient Consent to Examine forms and bring with you on the day of your appointment.  For your convenience, you may fill out the form using our interactive PDF format prior to printing the form.

Technical Note


You need Adobe Acrobat Reader to view our form. Please download the free Acrobat Reader from Adobe's web site if it is not already installed on your system

COVID-19 (Coronavirus) Update - In accordance with the guidelines established by the State of Ohio, we will be open for all dental appointments and procedures starting on May 4, 2020.  We are committed to maintaining the health of our patients, staff and community and will ensure that our safety protocols meet or exceed the standards necessary to accomplish this.  We ask that if you are experiencing Covid-19 Symptoms, please contact our office to reschedule your appointment.