Patient Forms

The tooth fairy requires the following forms to be filled out before your visit! Completing the forms help to speed up the check in process at our facilities. If you are a new patient try to arrive 15 minutes prior to your visit so that the necessary information may be placed in your file or email a copy of your completed form to

New Patient Health History

Record Release Form

Instructions After Your Extractions/Surgery

Instructions on Care for your Dentures

Instructions on Bleaching Appliances

Instructions on Maintaining Ortho Appliances


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Our Offices


513 South Main Street,
Moultrie, Georgia 31768
(229) 890-3909
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8455 Hwy 85, Building 500, Suite 100,
Riverdale, Georgia 30274
(770) 897-8991
(770) 897-8992
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Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.