BALLARD DENTAL CARE Dr. Jeffery Cole
BALLARD DENTAL CAREDr. Jeffery Cole

new patient paperwork

Please complete the following two documents and email them to us at ballarddentalcare@gmail.com. Due to COVID-19, we can no longer accept any forms in person. You can print and scan or fill out the PDF online, save your edits and email them to us. If needed, we can mail to you and have you send them back or drop in our mailbox outside the front door.

Patient Registration.pdf
Adobe Acrobat document [330.5 KB]
Financial Privacy Policy.pdf
Adobe Acrobat document [1.8 MB]
If you have current records at another office, please fill out and send this release form as well.
Records Release Form.pdf
Adobe Acrobat document [257.0 KB]

Your smile is an investment for a lifetime!

 

The greatest compliment our patients can give is the referral of their friends and loved ones.

 

Refer a friend or family member to us and be sure they mention your name so that we can personally thank you. We'll also send you a $25 gift card to show our appreciation.

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