New Patient Forms

Please print and fill out our New Patient Paperwork below before your appointment. Filling out the New Patient forms before your first appointment will make the check in process faster! If you have insurance please bring your insurance card with you the day of your appointment.


Please arrive 10 minutes early if you are unable to fill out the New Patient paperwork below. If you need to cancel an appointment, we ask that you please cancel within 24 hours of your appointment time to allow for another patient to take that appointment.

New Patient Form

Payment Methods Accepted:

Visa Payment Accepted
MasterCard Payment Accepted
Discover Payment Accepted
Cash Payment Accepted
Check Payment Accepted

Health Savings Account Cards

CareCredit

We are In Network with the following insurance plans:

  • Anthem Blue Cross Blue Shield 
  • Cigna
  • Delta Dental Premier and PPO  
  • Lincoln Financial Group 
  • Metlife
  • United Concordia
  • Dental Consultation – Cape Girardeau, MO – Harter Family Dental

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