New patient forms to fill out at home
Save time at your first visit: print both forms, fill them out at home and bring them with you.
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Patient registration form
Your contact details, insurance and an emergency contact.
Open the patient registration form (PDF, 377 KB)
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Medical history form
Your dental and medical history, allergies and medicines.
Open the medical history form (PDF, 65 KB)
Questions about a form? Call Franklin at (317) 736-9546 or Edinburgh at (812) 220-2676. Please bring the forms with you rather than emailing them, since they carry your health information.
Come see us in Franklin or Edinburgh
Whether it has been six months or six years since your last visit, a request takes a minute. We call you back to find a time that suits you.
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Franklin
884 West Jefferson St, Franklin
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Edinburgh
206 S. Main Street, Edinburgh