Patient Forms, Map and Directions to Southfield Office
Our office is a state-of-the-art dental office in Southfield, Michigan. Our goal is to provide you with a professional, comfortable environment where you receive the highest quality dental care and attention…from the front desk team to the doctors.
Our dental office team of motivated professionals possess the highest standards of integrity, excellence and enthusiasm for your care. We maintain a high level of excellence through a firm commitment to continuing dental education for each member of our dental office team.
Our Mission is to provide the highest quality dental care available for our patients through combing the most current, “State of the Art” technology with personalized one-on-one care for each and every patient.
Our dental office team consists of motivated professional, each possessing the highest standards of integrity, excellence and enthusiasm for his or her work. We maintain these high standards through a firm commitment to on going continuing education for each member of our dental office team.
The goal of our dental team is to provide each of our patients with a professional, comfortable environment where they will receive quality care and attention from all of our positive supportive team members.
Patient Forms
Pre-Visit Forms
- First Visit Letter – coming soon...
- Patient Registration and Assignment of Insurance Benefits – [PDF]
- Dental and Medical History – [PDF]
- Notice of Privacy Practices
- Acknowledgement of Receipt of Notice of Privacy Practices - [PDF]
Note: Pdf Forms will open in Adobe Reader/Acrobat when you click the links.
Click to download:
