FIRST VISIT OVERVIEW
Thank you for selecting Dr. John Mrozek & Dr. Philip Peluso for your dental care. Your first visit to our practice establishes a vital foundation for our relationship with you. During your first visit, you will have the opportunity to let our doctors get to know you so that we may obtain critical information in order to provide you with the most comprehensive dental care. We understand that every patient is different, and we treat each patient as an individual with unique dental needs and conditions. To ensure that we properly diagnose your dental needs, your first visit with us will include a comprehensive exam and all necessary x-rays. Our clinical team will review the results of your exam and x-rays and discuss any necessary future treatment you may need. Our staff of caring and dedicated professionals look forward to working with you to create the healthy smile you want.
WHAT TO BRING WITH YOU
- A valid government issued ID
- Your dental insurance card (if you have insurance)
- Dental X-rays (if avaliable) (must be dated within six months)
- Completed patient forms (5 forms in total)
- Minors under 18 years old must be accompanied by a parent
- Face mask or face covering
Patient Forms
NEW PATIENTS
In order to streamline your visit, you can access our patient forms online and complete them at your convenience.
To complete and submit your patient forms ELECTRONICALLY, please use the links below:
- Registration Form (office code: SMIL-AF3A3E)
- Health History Form (office code: SMIL-AF3A3E)
- Pre-Appointment Questionnaire
Financial Policy Form (** coming soon** please see below to download and print)
HIPPA Consent Form (** coming soon** please see below to download and print) -- Read HIPPA statement here
Otherwise, you can DOWNLOAD* and fill out all these forms and bring them with you to your appointment:
1. Click on the link below to pen the form in a new tab
2. Click on the "download" button to save the form to your computer
3. Once downloaded, open each of the PDF documents in Adobe Reader, fill out, and print.
- Registration Form
- Health History Form
- Pre-Appointment Questionnaire
- Financial Policy Form
- HIPPA Consent Form- Read HIPPA Statement here
*Please be aware that Adobe Acrobat Reader is needed to download these forms.
