About Us
Sedation Dentistry
Cosmetic Dentistry
Lumineers
Teeth Whitening
Orthodontics
Dentures
TMJ / TMD
Apnea/Snoring
Healthy Gums
Dental Topics
Payment/Insurance
New Patient Forms
Map / Hours
Contact Us


New Patient Forms

New patient forms are in PDF format. Click on the link to download the forms. Then print the forms, fill them out, and bring them with you on your first visit. Also, after reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it, and bring it in, too.

If you do not have Acrobat Reader, get a free copy by clicking on the link below.

Adobe PDFAdobe ReaderPatient Registration

Adobe PDFLumineers Smile Evaulation

Adobe PDFDental Insurance Information

Acknowledgement of Receipt of Notice of Privacy Practices

 

About Us | Mini Implants | Cosmetic Dentistry | Lumineers | Teeth Whitening
Orthodontics | Dentures | TMJ/TMD | Apnea/Snoring | Healthy Gums | Dental Topics
Payment/Insurance | New Patient Forms | Map/Hours | Contact Us

© Copyright 2003- Dental WebSmith, Inc. and Mike Beckham, DDS. All rights reserved. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.

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Michael Beckham, DDS, 350 E. Bell Road, Suite 211, Phoenix, AZ 85022 (602) 375-1517