If you are a new patient to our office, please click on the forms and fill them online. We use a third party service to keep your information secured.
For each form you will need to fill out your name and birth date.
- Patient Registration
- Medical History
- Privacy Practices
- Financial Policy
- 24 Hour Cancellation Policy
- HIPPA Information
At the front desk, our friendly staff will welcome you and provide you a series of forms to fill out.
Dr. Holina and Dr. Jacobs will perform a through examination of your mouth and provide insight on aesthetic materials for your treatment plan.
We will discuss with you cost of treatment and payment options if needed
WE ARE HERE FOR YOU
At Designs in Dentistry we will make you feel comfortable and welcomed because we care about your health.
We understand sometimes dental treatment might be overwhelming.
We promise we are always here to help you have the best painless and stress free experience.
