Patient Forms

NEW PATIENT FORMS

            Please click on the forms below to fill them out online.  You may then click Submit and email them directly to Dental Solutions.  If you do not have email, please print the appropriate forms, complete them, and bring them with you to your dental appointment. We look forward to seeing you soon!

 

            Adults should complete the following forms: Patient Information, Medical History, Dental History and Velscope Consent. Childeren 17 and under should complete the following forms: Patient Information, Medical History, and Dental History

 

Patient Information

Medical / Dental History

Velscope Consent

Located in Warsaw, Dental Solutions serves dental care patients from New Paris, Lessburg, Syracuse, Pierceton, Milford, North Webster, Atwood, and Claypool. Contact us today to make an appointment.

dental patient forms
William B. Stofer, DDS • 3505 N. State Rd. 15, Ste., Warsaw, IN 46582 • (574) 269-1199
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