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
Patient Health/Medication List, 13 & Older
Growth & Development Form, 12 & Under
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
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.