Patient Forms, Map and Directions to Rose City Office

If this is your first visit please be sure to bring with you:

• Your health care insurance coverage may have been discussed before you arrive, but please bring your Dental insurance ID card.
• Photo ID
• A list of all prescription or non-prescription medications you have recently taken or are taking now.

Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

• Earn the trust and respect of our patients, community and dental colleagues.
• Exceed your expectations.
• Ensure a creative, challenging and compassionate professional environment.
• Strive for continuous improvement at all levels.

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Patient Forms
Please print and fill out these forms so we can expedite your first visit:

• Registration Form
• Dental History Form
• Medical History Form
• HIPAA Form
• Financial Policy

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

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What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. We look forward to your first visit.