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.pdf - Included in this PDF is our Client Information Form, Medical Information Form, Consent for Treatment Form, Acknowledgment of Privacy Practices, and Financial Arrangements Form

Testimonials

I had a broken tooth and needed emergency care. I was able to get in almost immediately. Dr. Krempa gave me more than one option as to the care and length of time it would take for each of the options provided. My tooth was fixed and I was on my way in a short amount of time. I have always had fears and pain with dental work from other dentists. This was the best experience I have had. I have found my new dental provider. From the time I walked in and was greeted with smiles, to the time I left, it was a great experience with everyone there.--Suzanne B.

Go to top