Patient Forms

We look forward to meeting you!  We want you to know that we value your time a great deal and want your first visit with us to be as smooth as possible.  Please fill out the following new patient form before your appointment:

Additionally, you can print off the following new patient form and bring it to the office, but it will take longer to process. 

If you’re unable to open PDF files, you can get Adobe Reader® for free.

 

We are excited to be able to open slowly and see our awesome patients!  We have really missed seeing everyone and can not wait to return to some semblance of normal.  We understand that there is still a lot of unknowns regarding COVID-19, but rest assured we are following all of the guidlines suggested by the CDC, ADA, KY Board of Dentistry, and KDA and then some. We are prepared to treat everyone safely, but need all patients to complete the following forms before being seen in the office. 

Please fill out both forms once and submit:

AAOIC Supplemental Informed Consent: COVID19InformedConsent
AAOIC Supplemental Health Questionnaire: SupHealthQuestionnaire

schedule an appointment
Somerset
23 Commercial Dr
Somerset, KY 42501
(606) 679-8436
office hours
Mon – Wed: 8 am - 5 pm (EST)
Fri: 9 am – 3pm (EST)
columbia
650 Glenmary Dr
Columbia, KY 42728
(270) 384-2910
office hours
Thur: 9 am – 4:30 pm (CST)