Patient Forms
We are pleased you have decided to join us!
Preventive dentistry will contribute to your overall good health and we compliment you for getting started.
Help us get you started! Below you will find printable medical history and patient registration forms to register you as a new patient in our office.
Save time by getting these forms to us before your appointment.
You can e-mail or mail these forms to us ahead of time so that we can have all of your insurance benefit information prepared for you, or you can bring these forms with you on your first visit to our office. We also ask that you bring along all dental insurance cards so we can make a copy for your records.
Also below, we have our Insurance Policy, Office Policy and Procedures, Payment Options, and Notice of Privacy Practices forms available to print.
Thank you for your participation and please call
(636)464-2002 if you have any questions or concerns.
Our e-mail address is: schmitzdmd@msn.com
Insurance Policy
Medical History Form
Notice of Privacy Practices
Office Policy and Procedures
Patient Registration Form
Payment Options