New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

 

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (267 KB)
 

Patient Questionnaire

Please download, print and complete this form before your first dental appointment.
Click here to download (117 KB)
 

Member Savings Plan

Please download, print and complete this form to join our Member Savings Plan.
Click here to download (93 KB)
 

Financial Policy

Please download, print and complete this form before your first dental appointment.
Click here to download (13 KB)
 

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (1.6 MB)
 

HIPAA

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (400 KB)
 

Records Release

Please download, print and complete this form if you want to give us permission to release your records.
Click here to download (77 KB)
 

 
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Our Office

Southwest Dentistry
3391 Farm Bank Way
Grove City, OH, 43123
United States

614-594-2002
Map & Directions

Office Hours*:
Monday8:00am-6:00pm
Tuesday 9:00am-5:00pm
Wednesday12:00pm-6:00pm
Thursday9:00am-6:00pm
Friday 8:00am-12:00pm


*By Appointment Only