Patient Forms

Call 205-221-4048

If you are a new patient to our Jasper dental office, the forms below will need to filled out when you arrive for your first appointment in our dental office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival. Thank you and please call our dental office if you have any questions or need any assistance. 

New Patient Registration Form 

Medical History

HIPAA Privacy Act 

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.