Patient Center
Patient Forms
Filling out your paperwork before you arrive means less waiting and more time for the reason you came in.
- 5-star patient reviews
- Accepting new patients
- Most insurance accepted
- CareCredit financing
Take a few minutes at home to download and complete our new patient forms. Bring them with you, or drop them off ahead of time and we will have everything ready when you walk in. Prefer to fill them out in the office? That is completely fine. Our team will hand you a clipboard and help with anything that needs clarifying.
New Patient Registration
Your basic contact information, emergency contact, and preferred communication.
Form file coming soon.
Medical & Dental History
Current medications, allergies, and past dental care so we can plan safely.
Form file coming soon.
HIPAA & Privacy Notice
How we protect your information and your rights as a patient.
Form file coming soon.
Insurance Information
Insurance carrier, member ID, and subscriber details so we can file for you.
Form file coming soon.
Reserved for online forms
Secure online forms
We are preparing a secure online forms experience so you can complete everything on your phone or laptop. The embed will drop into the space below when it is ready.
Online forms embed slot
A secure forms provider (for example, an online intake or e-signature tool) will be embedded here. In the meantime, please use the downloadable PDFs above or complete forms in the office.
Not sure which forms you need?
Give us a quick call and we will point you to the right ones based on your visit.
Ready when you are
Schedule Your Appointment Today
Send us a quick note. We reply within one business day. Prefer to talk right now? Give us a call.
- 167 Lakewood Dr., Batesville, MS 38606
- 662-561-0100
- Mon – Thu: 8:00 AM – 5:00 PMFriday: 8:00 AM – 2:00 PMSat – Sun: Closed