Patient Forms

We love to make you smile and can’t wait to care for you! Call 734-426-8360 to get started today. Below are links to our digital patient forms.  Once you’ve downloaded and completed your forms, you can email them to us at dexterdentalstudio@gmail.com.  Filling out your forms online saves time and paper.

Adult New Patient Forms

Patient Registration Form

New Patient Health/Medication List

Dental History

HIPAA Release Form

Child New Patient Forms

Patient Registration Form

Child Age 4+ Health/Medication List

Infant to Age 3 Paperwork

HIPAA Release Form

Consent to Treat Minor Without Parent/Legal Guardian

Authorization of Minor Accompany Form

Annual Medical Health Update

Patient Health/Medication List

Dental Health Plan Subscription

Whole Dental Health Subscription Contract

SCHEDULE AN APPOINTMENT 

We follow precautions for COVID-19 to keep everyone safe.  

GET IN TOUCH

Payment Options

We provide a variety of individualized health packages to meet your budget and needs.

Visit

Schedule your appointment Now

We follow precautions for COVID-19 to keep everyone safe.

Pin It on Pinterest

Share This