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


Dr. Krempa did an excellent job! I usually dread going to the dentist, but he was very gentle and caring. He asked me if I was comfortable and took the time with me in understanding my treatment options. His use of technology was really nice because it allowed me to view my teeth on a big screen TV. I was amazed how wonderful my teeth felt after my visit. I will definitely go back!  -Google User on June 18, 2013

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