New Patient Kit

For your convenience, we have made our Patient Information Form and Medical History Form available on our Web Site. Both forms are in Adobe Acrobat (PDF) format. If you need to download a copy of Adobe’s free Acrobat Reader to view or print the forms, please click here.

Please complete both forms and bring them with you to your first visit to our office.

Thank you!

David M. Vierhus, D.D.S.
Terri L. Brummitt, D.D.S.

Click the image above to view, print or save a copy of our Patient Information Form.

Click the image above to view, print or save a copy of our Medical History Form.