accessibility ACCESSIBILITY

New Patient Forms for Shalimar Family Dentistry

480-447-1901


To make your experience even better our new patient forms are available right here on our website.  Please print and fill out the following documents and bring them in on your first visit.  Our Tempe Dental team will do the rest!

 

Are you an Adult Patient (18 years and older)? You will need:

SFD-HHX-2015 (1).pdf  

SFD-Adult health and info packet 14 (3).pdf


Are you a Young Adult Patient (17 years and younger)? Your parent/guardian will need:

New Patient- Child Packet SFD (14) (1).pdf

For your records our Privacy Policy is available:

HIIPPA Policy.doc

 

 

 


Items in bold are required.
Name:  
Address:
City:
State/Province:
Zip/Postal:
Phone:
Email:
Are you a current patient?
Best time(s) to call?
Preferred day(s) of the week for an appointment?
Preferred time(s) for an appointment?
Please describe the nature of your appointment (e.g., consultation, check-up, etc.):
 
 

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

 

OFFICE HOURS:

Monday:       7:30am -5:00pm

Tuesday:      7:30am -5:00pm

Wednesday: 7:00am -7:00pm

Thursday:     7:00am -7:00pm

Friday:          7:30am -2:00pm