Printable Option
Step 1
Download and complete the following forms:
(All forms require your computer to run Adobe. If you do not have Adobe installed, please click here).
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
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 return to our office before your appointment in order for us to be prepared for your visit. Thank you.)
- TMJ Screening Form – This 1 page TMJ screening form is used for patients who are wondering if they have an issue related to TMJ. Please contact the office if you have questions.
Step 2
Send the form back to our office 24 hours before your appointment by:
Email:
info@drgrapevinedds.com
Fax:
972.964.2387
Mail:
1200 Coit Rd, Suite #100
Plano, TX 75075