Forms

We understand your time is valuable and have simplified our office experience with printable patient forms you can complete before your appointment. We ask that you fill out these forms to help us better understand your health background so we can provide the most effective care possible. Please call us with any questions you have!

Your First Visit

Your first visit with Kimberly Dental includes a review of your dental and medical history, complete X-rays of teeth and mouth, and an oral exam.

Please assist our staff by bringing the following information with you to your first dental appointment:

  • Completed health history forms
  • Your insurance card and the necessary completed forms
    • This will allow us to help you process any claims.
  • Any X-rays from your referring dentist
    • If you’ve had recent X-rays taken with a previous dentist, you can request that they forward them to our office.
  • A list of all medications you are presently taking

Please notify the office if you have a medical condition or concern prior to surgery (i.e., diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e., heart medications, aspirin anticoagulant therapy, etc.) or require medication prior to dental cleanings (i.e, antibiotics, for pre-med).

Children Under 18

PLEASE NOTE: Any child under the age of 18 will need to be accompanied by a parent or guardian at the consultation visit.

Medical History Form

Patient Information Form