Patient Forms Jacob Grapevine, DDS

Online Forms

Step 1
Download and complete the following forms:

New Patient Forms

• Patient Info
• Dental Health Questions
• Medical History
• Financial Policy
• Jacob Grapevine, DDS Consent
• Notice of Privacy Practice
• Acknowledgment of Receipt
• Appointment Cancellation Policy

Step 2
Send the form back to our office 24 hours before your appointment by:

Fax:
972-767-4716

E-Mail:
info@drgrapevinedds.com

For our TMD patients, In addition to the new patient forms please fill out the appropriate forms below for your examination.

New Patient TMD Forms

• New Patient Questionnaire for TMD Issues (please fill out the 3 page form and email it to our office at info@drgrapevinedds.com.  We will contact you once we receive the forms)