(386) 734-5352

Patient Form >>

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

 

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

 

Patient Medical History Form
New Patient Information.doc
Microsoft Word document [126.5 KB]

 

New Patient Questionnaire
New Patient Questionnaire.doc
Microsoft Word document [22.5 KB]

 

 

Office Hours and Appointments

We are open for appointments from:

Monday from 8:00 A.M. - 5:00 P.M.

Tuesday from 7:00 A.M. - 1:00 P.M.

Wednesday from 8:00 A.M. - 5:00 P.M.

Thursday from 9:00 A.M. - 6:00 P.M.

Friday morning appointments by request 

Should you require emergency dental service,
please contact us at (386) 734-5354.

Dr. Prakash is on-call 24 hours a day, 7 days a week.