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  • Benton, AR - 1112 Military Rd. 72015
  • Benton, AR - 1215 Military Road Suite 5 72015
  • 501-778-7129 | Benton, AR - 1112 Military Rd.
  • 501-315-5574 | Benton, AR - 1215 Military Road Suite 5

If you are a new patient to our office, the attached files contain our new patient forms that will need to be filled out when you arrive at our Benton dental office. Printing them, filling them out and bringing them with you will allow us to attend to you more quickly than completing them on your arrival. Thank you and please call our office at (501) 778-7129 should you have any questions at all.

NEW PATIENT FORMS

NOTICE OF PRIVACY PRACTICES

ACKNOWLEDGEMENT OF NOTICE OF PRIVACY PRACTICES

AUTHORIZATION FOR RELEASE OF IDENTIFYING HEALTH INFORMATION

 

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

 

 

Dental Health

As dental professionals it is our priority to provide quality dental care you can trust.

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