We can help you...

Downloadable Forms

Please download the following forms and fill them out.  If you choose to submit this completed form before your scheduled appointment, it will assure faster processing of your paperwork.  When you arrive for this appointment all you will have to do is validate that it is accurate and up-to-date.

If you need help reading the file: Download Adobe Reader by clicking on the image below.

Patient Information

 

Download the Form HERE

Please download the form and print it.  Fill out the form and bring it to the office during your visit.  We will also accept this form by mail, e-mail, or fax.

Family Dentists, PLLC
1936 Holland Avenue
Port Huron, Michigan 48060

Fax: 810-987-2692

contact@porthuronfamilydentists.com

 

 

Medical History Form

 

Download the Form HERE

Please download the form and print it.  Fill out the form and bring it to the office during your visit.  We will also accept this form by mail, e-mail, or fax.

Family Dentists, PLLC
1936 Holland Avenue
Port Huron, Michigan 48060

Fax: 810-987-2692

contact@porthuronfamilydentists.com

 

 

Notice of
Privacy Practices

  Download the Form HERE

 Please download the form and print it.  Fill out the form and bring it to the office during your visit.  We will also accept this form by mail, e-mail, or fax.

Family Dentists, PLLC
1936 Holland Avenue
Port Huron, Michigan 48060

Fax: 810-987-2692

contact@porthuronfamilydentists.com