Patient Forms
Save time by completing your patient forms online or at home, ensuring a relaxed and efficient dental visit. If you have any questions, please call our office at (937) 293-3402.
Submit your patient forms in advance
We understand that your time is valuable. That's why we offer the convenience of completing your patient forms online or at home, allowing you to save time and streamline your visit. Whether you're a busy professional or a family on the go, we're here to make your dental experience as relaxing as possible.
You can access the forms with the buttons below and may complete your forms at your convenience one of two ways: you may fill them out digitally, then save them to your computer and email them to us at [email protected], or you may print them out at home and bring the completed forms to your appointment.
What You’ll Need
Whether filling out forms for the first time or updating your personal information, please have your insurance card and a list of current medications ready. Please inform us immediately if you’ve recently had surgery or a hospital stay.
Fill Out Forms Online
Registration
Prior to your first visit, we will add your personal and insurance information to our records.
Medical & Dental History
We require an accurate medical and dental health history prior to beginning treatment to ensure that we are recommending the best and safest treatment for you and your family.
Private Health Information and Communication
We follow all HIPAA guidelines and will only release medical information to approved individuals.
Notice of Privacy Practices
This notice describes how your health information may be used, disclosed, and how you can get access to this information.
Google Reviews
It was the best dental visit I’ve had. I almost went to sleep in the chair after getting a cavity fixed and having crowns put in. There was NO PAIN AT ALL! I definitely recommend their services. Dr. Ryan, Kashel, and all of the staff were great!
This place is awesome. The staff is wonderful. They are so kind, polite, and very helpful. You are treated with respect. I would recommend this place 100 percent.
Great staff. Friendly and professional. The AQP definitely knew what she was doing. I highly recommend Platinum Dentistry for all your dental needs.
I came in as a new patient with a broken tooth, and Dr. Platt was ready within minutes to remove it pain-free. This was hands down the best dental experience I’ve had, and it will be my new dental office from here on out.
I came to this practice in a state of pure panic and chaos. From my first interaction over the phone, I immediately felt that I could trust their entire staff. The Platts are both very knowledgeable and skilled, and I am eternally grateful to them. They helped me overcome my dental anxiety and regain confidence in my smile. I live over an hour away, and they are worth the drive.
After having cancer in my jaw, I was very scared to see a dentist. Dr. Platt was incredible and made me feel like we were in this together. He heard me (and my fears) and gave me so many options that together, we could find a plan I was comfortable with. He is the first dentist I’ve gone to in 46 years, and it didn’t hurt, and for me, that’s huge! He’s allowed me to not be ashamed of my smile.
After 18 months of trying to find a dentist for my son, age 19, with autism, I have been truly blessed to find the most patient, kind, and respectful office staff in a very long time. Thank you for a fantastic patient experience. Truly a blessing.
Absolutely fantastic!! I had an emergency, and Dr. Platt was able to see me within 90 minutes. He was able to extract the tooth right there. All the staff were friendly and provided excellent service. He is now my new dentist.
