PATIENT FORMS

PATIENT

FORMS

Please download and fill-out our digitally fillable Patient Registration, Medical History, and COVID-19 Consent Forms. After you have completed the forms, please make sure to bring them with you on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Please download and fill-out our Patient Registration, Medical History, and COVID-19 Consent Forms. After you have completed the forms, please make sure to bring them with you on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

TECHNICAL NOTE

You need Adobe Acrobat Reader to view our forms. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.

TECHNICAL NOTE

You need Adobe Acrobat Reader to view our forms. Please download the free Acrobat Reader from Adobe’s web site if it is not already installed on your system.

YOUR JOURNEY TO A HEALTHY SMILE STARTS HERE!

YOUR JOURNEY TO A HEALTHY SMILE STARTS HERE!

DECORAH

563.382.4302

511 W Water St., Ste. C
Decorah, Iowa 52101

LANSING

563.538.4673

267 Main Street
Lansing, IA 52151