PATIENT
REGISTRATION

MONDAY-FRIDAY:
7:00 AM – 7:00 PM

SATURDAY (By Appointment)

Patient Registration

As our new patient, it is of primary importance to us that you feel comfortable and prepared for your first visit. While our focus is on the health of your teeth and gums, your mouth is part of your greater health and well-being, which is our main priority. With this in mind, we will need to learn more about you and your overall medical history and present conditions.

The new patient registration form requests your basic personal and contact information, but also a medical history and an appearance and goals questionnaire. Please print them at home or work and fill them out, or come a few minutes early.

Don’t Forget

  • Download the New Patient form and bring it in during your first visit with us.
  • Please arrive 15 before your scheduled appointment time.
  • We will be giving you a tour of our office and a new patient gift.
  • After your tour we will do a new patient consultation.
  • Then enjoy you’re your stress free dental experience!

New Patient Intake Information Form: This is personal and confidential contact information and your insurance information.

New Patient Medical History Form:
Health problems that you may have or medication that you might be taking could have an impact on the dentistry you receive. An accurate and complete medical history will allow us to make the best decisions for your dental and overall health.

New Patient Appearance and Goals Questionnaire: Telling us about yourself and your levels of satisfaction with your dental health will aid our staff in understanding your needs, whether they are required treatments or cosmetic improvements.

Notice of Privacy Practices and Acknowledgement of Receipt and Your Consent Signature: The privacy of your health information is very important to us. Please carefully read through the Privacy Practices and then sign the Receipt and Consent form.

New Pediatric Patient Dental and Medical Health History: A child’s personal, parental, insurance, dental history, and medical history are important to properly start your child down the path of healthy teeth and gums.

Credit Card Authorization Form: At Lifetime Family Dental, we have a policy requiring a credit card, pre-authorized by the patient for payments, in the event that insurance doesn’t cover the entire bill.

YOUR FIRST VISIT

What to bring:

Your initial consultation will include a review of your dental and medical history, so it is important that you print out and complete the relevant new patient registration documents provided online. Even if you included it in your paperwork, while you are talking with Dr. Gudger or the office staff during your first visit, please alert us to whether you have more serious conditions like diabetes, high blood pressure, rheumatic fever, or artificial heart valves and joints. A complete description of your medications is necessary, especially ones like anticoagulant therapy, a daily aspirin regimen, or heart medications. If you have dental insurance, please bring all the information with you as well, so that reimbursement is quick and easy.

Treatment

Many people can feel overwhelmed whenever there is paperwork and finances involved in any appointment, but our expert staff is professional and efficient. In fact, most new patients who come into Lifetime Family Dental for a consultation either complete or start their treatment on the same day. This is especially helpful for emergency visits, and our administrative staff can handle even the most complex scheduling situations.