New Patient Forms












New patients will be required to furnish us with the following information prior to their first visit.  

This information will include:

  • Patient Information
  • Emergency Contact Information
  • Insurance Information
  • Cancellation Policy Acknowledgment
  • Medical History
  • Dental History
  • Consent for Treatment Form
  • Acknowledgment of Privacy Practices
  • Financial Arrangements 
If you would like to fill out and print your new patient forms prior to arriving at the office, please download the following document:

New Patient Forms.doc - Included in this Word Document is our Client Information Form, Medical Information Form, Consent for Treatment Form, Acknowledgment of Privacy Practices, and Financial Arrangements Form   

Testimonials

I've been to 3 Dentist in Mobile,Al. and wasn't happy at all,then I found Dr. Krempa on line.I left his office very happy.Great staff,and Dr. Krempa explains everything to you,and you don't feel rushed,very caring place.I will tell all my family and friends who to go see if they need a dentist.--Vicky W.

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