Patient Forms

We’ve compiled our most used patient forms here so that you can fill them out in the comfort of your home or office.

New Patient Form

Welcome to our practice! Save time by completing this form prior to your reserved visit.

Request an Appointment

We’d love to see you and your smile. Click here to request your appointment with us.

Medical History Update

Having updated information allows us to provide quality, comprehensive care for your child. Please inform us if there have been any changes to your personal contact information or dental insurance.

Thank you for choosing Southern Smiles! Has your child been seen at another dental practice? If so, this completed form will allow us to request all appropriate records prior to your child’s first visit.

Patient Forms

New Patient Form

Request an Appointment

Medical History Update

Records Request

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