229.227.1447   |   303 W. Hansell St.   |   Thomasville, GA 31792

FORMS

 

Is this your first visit to our office?

Valuable time can be saved by providing us with the necessary new patient information in advance. Please print and complete the Patient Registration and Medical History Form and the Notice of Privacy Practices.

 

Are you currently a patient of ours?

You may also use the Patient Registration Form to update any information which may have changed since your last visit.

 

  1. Verify that you have Adobe Acrobat Reader installed on your computer.  If you need Acrobat Reader, it is a free download and can be installed by visiting www.adobe.com.
  2. Click the link below for the form(s) you wish to download.
  3. Print the form(s) on your printer and complete each form.
  4. Bring the form(s) to our office for your appointment.
  5. Save lots of time!

 

Download Forms

Patient Registration

 

Notice of Privacy Practices

 

Inside our Holland Operatory

See more pictures in our Photo Gallery!

Sharon Patrick, DMD © Copyright. All rights reserved. Finely Crafted & Powered by CCB Tech Group.

CONTACT US

Office: 229.227.1447

Fax: 229.227.1486

Address: 303 W Hansell St., Thomasville, GA 31792

Email: contactus@aconfidentsmile.com

Please use this for general practice inquiries only.

For Map and Directions

Find us on

Facebook, Instagram, & YouTube!