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 wonderful experience today at the office – I had a root canal after a deep cleaning. I was very nervous about this procedure with a new dentist, but now, I am very comfortable with having all my dental needs met with Dr. Krempa and his staff! He not only is knowledgeable, gentle and caring, he is painless!!! So I know I am in good hands now, and that's a wonderful feeling. I will definitely be recommending Dr. Krempa!

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