Patient Forms

You can either download the form by clicking below, or you can arrive 15 minutes early for your first visit.

This new patient form gives our dentists the information they need to get a good sense of your dental health and your overall health.

New Patient Form

General Consent Form

Financial Agreement Consent Form

HIPPA Consent Form

At our dental office, we accept most types of dental insurance, including:

  • Delta Dental PPO / Premier
  • Humana,
  • United Health Care,
  • Cigna,
  • Aetna,
  • Guardian,
  • MetLife
  • We welcome military families, and we also accept Tricare insurance.

If you have any questions about the new patient form, please call our office, (719) 596-1011.

Please note: If you have dental insurance, please bring your dental insurance card and information to your first appointment

Patient Forms Colorado Springs Family – General – Cosmetic Dentists

Prior to your first dental visit, we’ll need you to fill out a new patient form.

Premier Dental Care

685 Citadel Drive East
Suite 302
Colorado Springs, Colorado 80909

Monday  7:30 – 5:00
Tuesday  7:30 – 5:00
Wednesday  7:30 – 5:00
Thursday  7:30 – 5:00
Friday 7:30 – 1:00