Patient Forms

New Patient FormsNew Patient Information:

Your first visit:

We will make every attempt to stay on time for your scheduled appointment.

Because your overall dental health is important to us, we will begin with a thorough medical history and a review of any past dental history. We will perform a comprehensive head and neck exam that includes hygiene assessment and cleaning. Also, we will do an oral cancer screening, orthodontic evaluation, gum disease assessment and temporomandibular joint evaluation.

New Patient Forms:

For your convenience, please review, download and print. After completion of the forms, either fax, mail or bring them with you for your first visit.

You will need Adobe Reader to download and print the forms.

Payment is due upon completion of services.

We accept cash, check, Visa, Mastercard, Discover, and Care Credit.

CFCD Dental Care Plan
If you do not have insurance, please ask about our in house care plan. A reasonable savings for your dental care.

Best of Jackson 2012 - Jackson free Press

Clarion Ledger Best of 2015

Open Care Best of 2015

NextDoor Neighborhood Favorite 2017

Voted Best Dentist By Parents & Kids Magazine

Member of the Madison Mississippi Chamber of Commerce

Nextdoor 2018 Neighborhood Favorite