Patient Forms and Mission Statement
Your first visit to Bethlehem Smiles involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. Please clink on the link below to complete your new patient registration forms.
New Patient Forms
Online Forms: Click Here
- Medical History Forms - PDF
- Questionnaire - PDF
- Patient HIPAA Release and Update Form - PDF
- Record Release Form - PDF
- Consent to Treat Minor Children Form - PDF
In order to view or print these forms, you will need Adobe Acrobat Reader installed. Click here to download it.
" It is our goal to provide excellent dental care to those individuals who seek out care in our office. We will do so in the most professional manner and compassionate fashion. We will remain current and diligent, and remember that the patient comes first."
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve.
- Earn the trust and respect of patients, profession, and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.
What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.