New Patients

We are pleased to welcome you to our practice. Please take a few minutes to fill out these forms as completely as you can. If you have questions we’ll be glad to help you. We look forward to working with you in maintaining your dental health.

 

 

Mattoon Dental New Patient Forms

        Patient Information

        Primary Insurance

        Additional Insurance

        Dental History

        Medical History

        Authorization

Mattoon Dental Patient Forms

 

 

 

Health Insurance Portability & Accountability Act

 

 

TMJ Informed Consent & Questionnaire

        Questionnaire

        Informed Consent