Dentistry For You
Creating Beautiful Smiles
Call: (419) 586-1661

Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.


For children ages 1-12, please complete the following form:

Childs Health History.pdf


For children and adults age 13 and older, please complete the following form:

Adult Health History.pdf



This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.