New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (66 KB)

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (229 KB)

HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (295 KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

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Memphis Office

10 S Belvedere Blvd
Memphis, TN 38104
Map & Directions
 
Phone: (901) 725-4913
Fax: (901) 272-0530
 

Office Hours*:
Monday8:00am-5:00pm
Tuesday 8:00am-5:00pm
Wednesday8:00am-5:00pm
Thursday8:00am-5:00pm
Friday8:00am-5:00pm

*By Appointment Only

Cordova Office

8065 Club Parkway, Suite 2
Cordova,Tennessee 38016
Map & Directions
 
Phone: (901)756-0027
 

Office Hours*:
Monday8:00am-5:30pm
Tuesday 8:00am-5:30pm
Wednesday8:00am-5:30pm
Thursday8:00am-5:30pm
Friday8:00am-5:30pm

*By Appointment Only