We now offer our patients a convenient option to fill out all of their new patient forms online. No need to print or handwrite anything. Use our secure online platform to fill out all of your required patient paperwork.
Follow the links below to fill out your new patient forms on our online platform.
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
Send the form back to our office 24 hours before your appointment by:
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 email@example.com. We will contact you once we receive the forms)