Patient Forms


Complete your Health History Form and send via Email to:

If your computer does not have Adobe Reader, it can be downloaded here.



Cancellation & No Show Policy:

Missed appointments and cancellations not made within 24 hours will incur a $25 cancellation fee.

Cancellation Policy Agreement 

Appointment request
Need an appointment with a dentist in Atlanta ? Requesting an appointment at our Atlanta, GA family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Describe the nature of your appointment or any other comments