Patient Forms

Please print and fill out each one of the listed forms and bring it to your initial appointment.
 
New Patient Forms
 
 
 
 
HIPAA Forms
 
 
 
 
Appointment request
Need an appointment with a dentist in Crown Point ? Requesting an appointment at our Crown Point, IN family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Choose Location:
Preferred Appt Date
Preferred Appt Time
Message
Describe the nature of your appointment or any other comments