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 is the best dentist ever...first visit didn't have a long process in waiting my needs was meet same day. They staff is A1 caring and professional. If you looking for a dentist or even have a dental emergency this is the dentist to come to you won't be disappointed... Thanks Dr. Krempa and staff...--Rabiatu M.

Go to top