Patient Forms
Welcome to Center for Pediatric Dentistry! We look forward to meeting you!
During your first visit, we obtain important information necessary to treat your child including a comprehensive medical and dental history, insurance information and discuss any questions or concerns you may have about your child’s dental care. We also take the time to introduce your family to our doctor and our team here at Center for Pediatric Dentistry. Our highly-trained and compassionate team members strive to give the best care to each of our patients at every visit!
To expedite your first visit, please complete the appropriate paperwork below for the type of insurance your family has and bring all of the documents with you to the first visit.
New Patients
*Note: New patient paperwork must be completed and signed by a parent or legal guardian.
In order for our team to provide your child the best care, we will need any current records from your previous dental office. Please complete and return the Records Transfer form below to give your previous dentist permission to send us current records for your child.
Existing Patients:
If your family is moving or transitioning to a new dental practice, please complete and return the Records Release form below so that our staff members can assist in securely transferring your child’s dental records to your new dental office.
If you have any questions, please feel free to call our office at (706) 855-8989.
Please complete the appropriate paperwork above and bring all of the documents with you to the first visit. If you have any questions, please feel free to call our office at (706) 855-8989.
Contact Us to Schedule an Appointment or Ask a Question!