Patient Forms

New Patients:

We request that new patients print out required forms and complete prior to appointment and bring completed form to your appointment. If you are unable to print them out ahead of time please arrive 10 minutes early to complete your necessary health history forms, HIPPA Acknowledgement and Consent to Treat form.

Antibiotics may be required before any procedures (including cleanings) for the following conditions: joint replacements, Prosthetic cardiac valve, previous endocarditis, Cardiac transplantation recipients with cardiac valvular disease and some instances of Congenital heart disease. Please check with your cardiologist, orthopedic surgeon or family doctor if you are unsure if you are required to do so.

If you have had recent x-rays (obtained in the last 12 months) from another dentist, please contact them and bring them to your first appointment or have them sent to us at:

Village Dental Center
PO BOX 327
Goodrich, MI 48438
dawne@villagedentalcenter.org
(810) 636-2808 phone
(810) 636-4010 fax