Once you make an appointment, our office will ask you to provide patient registration details such as name and address, responsible party, consent for treatment, etc. You can save time by printing and filling out these forms yourself.

Bring The Forms With You
After you've completed the medical history and new patient forms, simply bring them with you on the day of your visit. Alternately, you can also fax them to us at (404) 622.0624 prior to your appointment.

Although it's not required, bringing completed forms with you will save time spent at our office and help make your first appointment less troublesome. If you have any problems downloading the forms, be sure to call our office and we will gladly help you.

Our online registration form is a PDF document file. You must have the current
Adobe Acrobat Reader installed on your machine to view & print the forms.

Patient History Form
Insurance Information Form
General Information Form

 

 

 

Copyright ® 2010 Southern Smiles. 475 Bill Kennedy Way, Suite D and E Atlanta, GA 30316 . phone: (404) 622-0622  fax: (404) 622-0624 Get Map

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