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


Mattoon Dental Patient Forms




Health Insurance Portability & Accountability Act



TMJ Informed Consent & Questionnaire


        Informed Consent