New Patient Forms

You may access the following forms to assist us with your care. Please print and fill out the desired form, then bring it to your appointment.

New Patient Form
Patient Information Form
Medical History Form

To submit your New Patient Forms online please click here designersmilesbybenton@gmail.com

Privacy Policy
Notice of Privacy Practices
Acknowledgement of Privacy Practices

New patient forms

Schedule a
Complimentary
Consultation

The first step toward achieving a beautiful, healthy smile is to schedule an appointment! Request a complimentary consultation and our scheduling coordinator will contact you soon to confirm your appointment.

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