PATIENT REGISTRATION

Please click on the link below to print the New Patient Forms,  fill them out completely and bring to your initial visit. You may also fax them to 352-259-6766 if you would like us to have them prior to your visit. Please let us know if you have any questions prior to your visit; we are all happy to help! 

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Please save and email the filled out forms to x-rays@villageperiodontics.com   

Please assist us at the time of your initial visit to the office by providing the following information:

• Your referral slip and x-rays from your referring dentist.
• A list of medications you are currently taking (please note that you can fill out your patient registration and medical history form on our website.)
• If you have dental benefits, please bring any forms or cards with you to the appointment.

Please Note: All patients under 18 must be accompanied by a parent or guardian at the consultation appointment.

Please notify the office if you have a medical condition or concern prior to surgery (e.g. artificial heart valves or joints, heart murmurs requiring pre-medication, severe diabetes, or hypertension).

We will complete an in-depth medical and dental health history and a thorough examination to measure for bone loss, loose teeth, bite, oral cancer screening, TMJ, and other signs of periodontal disease.