Dr. Terra Hickey and Dr. Philip Andersen, Center Point Family Dentistry in Center Point, IA
Center Point Family Dentistry in Center Point IA
 
New Patient Forms
   
 

formIf you would like to complete your registration form before you arrive, you may download it by clicking below. The new patient form is in PDF format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. Also, after reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it, and bring it in, too.

 


Adobe PDFAdobe ReaderNew Patient Form (Adult) (Acrobat PDF form)

 

Adobe PDFNew Patient Form (Child) (Acrobat PDF form)

 


Acknowledgement of Receipt of Notice of Privacy Practices
(web page)