Cape Girardeau
(573) 332-7223
Jackson
(573) 243-5985
Perryville
(573) 547-7411
Sikeston
(573) 475-9225
Poplar Bluff
(573) 785-1466
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Patient Forms

Welcome to the family! To help make your first visit as smooth and efficient as possible, we invite you to complete our new patient form beforehand. This saves you time in our office and allows us to focus on what’s most important—you and your smile goals!

Below, you’ll find a printable PDF form.

A close up of a tooth with braces on it

Online Form (Recommended)

This is the easiest and fastest way to get started. Simply click the link below to securely fill out and submit your forms from your computer, tablet, or smartphone.

Printable Form

You can print our new patient form for either child and adult and fill it out at your convenience. Bring it with you to your first appointment.

If you’re unable to open PDF files, you can get Adobe Reader® for free.