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Patient Forms

New Patient Forms: 

New Patient Paperwork (Word Document) or New Patient Paperwork (PDF)

Family New Patient Forms: 
Families with multiple children please fill out our new patient family form below with a medical history for each person:
New Patient Family Paperwork (Word Document) or (PDF)
Medical History Form (Word Document) or  (PDF) Only 1 medical history per person is needed.

 

We ask that you fill out the forms prior to your arrival of your first visit with us. You may email your forms to info@premiersmile.com to expedite your check-in process.

If you have any questions regarding the forms or need any assitance, please call the office at 402-718-8737.

We look forward to seeing you!

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