Patient Forms

Patient Forms

Patient Forms

Simply digitally complete the forms and they will be uploaded into your patient files. If you would prefer to complete them on paper, please feel free to print them and bring the paper copies to your first appointment. Once reviewed, we can discuss your needs and answer any questions you might have.

We appreciate your interest in Advanced Cosmetic & General Dentistry of DC and thank you for trusting us with your dental care.

IMPORTANT

Patients under 18 must be accompanied by a guardian on their first consultation visit.

Please let us know of any relevant medical conditions or medications before surgery in case they may interfere with treatment.

Request an Appointment
To book an appointment please feel free to call us at 202.331.1644 or complete the form below.

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Terms and Conditions

Here at Advanced Cosmetic & General Dentistry of DC, we work diligently to protect our patient's rights and privacy. Requesting an appointment via our Internet portal is considered part of what HIPAA has identified as electronically protected information (ePHI). Unfortunately, despite the best efforts we make or take, there are people or entities that may attempt to intercept the data you transmit to us. By checking the box, and electronically making an appointment, you understand that you are making an appointment over the internet and that Advanced Cosmetic & General Dentistry of DC will keep this information confidential but cannot guarantee that others, outside of our practice, may not illegally intercept this communication. As a result of continuing, you are sending this transmission and accepting the inherent risk(s) associated with making this request for an appointment. As an alternative, you are always welcome to contact our office via telephone to schedule your appointment.