New Patient Forms

Dr. Kent Johansen - 3800 W. Ray Road, Suite 11, Chandler, Arizona
Make Appointments Online  or Call 480-345-0530
 

Chandler/Tempe Dentist | Cosmetic Dentistry | Porcelain Veneers | Orthodontics | Teeth Whitening

 

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 Certified Invisilign® Dentist

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New Patient Forms

For your convenience you can now instantly download and print "new patient forms". For best duplication, we have provided PDF files. This includes a form requesting your general information and another form requesting your Dental/Medical information. After you have printed these forms at home, Please remember to bring your completed forms with you to your first appointment.

In order to read a PDF file you must use Adobe Acrobat Reader. This is a very simple process. Your computer may already have Acrobat Reader installed. If you do, it will automatically open when you click on the .pdf file. If you don't have it, you can download it free from Adobe:

If you have any problem getting these files to print properly, please call our office
480-345-0530 and we will gladly send or fax them to you..

 
 

How do I download & install the Acrobat Reader?
Step-by-Step instructions are provided when you click the icon below or via this link:
Adobe - Adobe Reader download

Please download both Forms and bring to office with you.

New Patient Information Form

Dental & Medical History Form

This information will be held in strictest confidence and your privacy is assured. You have our guarantee that we will never sell or give away any  information exchanged between you and Chandler Dentistry Center

 

©Copyright 2007 - 2009 Chandler Dentistry Center
Kent Johansen, D.D.S. Chandler Arizona 85226