Patient Forms

Call 906.863.2206
  • Menominee, MI - 4103 10th Street 49858
  • Daggett, MI - P.O. Box 99 49821
  • 906.863.2206 | Menominee, MI - 4103 10th Street
  • 906.753.2531 | Daggett, MI - P.O. Box 99

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Adult Medical History 

Child Medical History Form


This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


We combine experience with the latest in dental technology to deliver the best patient experience possible.