Patient Forms

Our New Patient and Medical History forms are now available for download so you can complete them at your leisure—saving you time waiting in our office and giving you time to carefully review our policies and procedures. If you would like to complete the forms before arriving at our office, please click the link below to download the forms in PDF format. You may print out the forms and bring them to your first appointment.

New Patient Form


Medical History Form


Payment & Financial Options

We are committed to providing dental care that is both high quality and affordable. Payment options include cash, Discover, Visa, checks, major insurance, MasterCard, and CareCredit. If you would like to extend payments over a longer period of time, we offer CareCredit. Click on the logo below for more information.

VISA MasterCard Discover CareCredit

We understand that unexpected dental bills can strain finances. If this happens to you, don’t hesitate to call us at (601) 992-1605 If you keep the line of communication open with us, we will be able work out an acceptable arrangement.

For questions about payment and financing, please contact our office. We are happy to help!