Patient Forms

Save Time by Completing Your Forms Before Your Visit

At Apopka Smiles, we want your visit to be as quick and easy as possible. Filling out your patient forms before your appointment lets you spend less time in the waiting room and more time with our team. It also gives our dentist the information they need to provide safe, personalized care.

Adult Patient Packet

Last update: 11/2020

The Adult Patient Packet includes the information we need before your first visit. Please complete every section as fully as you can, sign where indicated and bring the completed packet with you to your appointment.

What to Bring to Your Appointment

• Your completed patient forms
• A photo ID
• Your dental insurance card, if you have insurance
• A list of all medications, vitamins and supplements you take
• Any recent dental X-rays or records from a previous dentist, if available

Why We Ask for Your Health History

Your overall health and your oral health are closely connected. Certain medical conditions and medications can affect dental treatment, healing and the type of anesthesia that's safe for you. A complete health history helps our dentist plan treatment that's right for you. If you're preparing for a procedure with anesthesia, also review our Before Anesthesia instructions.

Insurance Information

Apopka Smiles wants each patient to get the most from their dental insurance. Our financial staff will submit insurance claims and all necessary forms to your insurance company on your behalf. We're in-network with most PPO insurance providers, and we accept checks, cash, all major credit cards and CareCredit.

Trouble Downloading Forms?

If you're having trouble downloading forms, try right-clicking the link and saving the file manually. If you still need help, call us or use the contact form. We're happy to help, and we can also provide forms when you arrive for your visit.

New to Apopka Smiles?

Welcome! Visit our New Patients page to learn what to expect at your first visit, and see our New Patient Forms page. New patients can also take advantage of our current Specials, including a $99 Complete Checkup + X-rays (limited time, cannot be combined with insurance).

Contact Information

Apopka Smiles 3030 E Semoran Blvd Suite 200 Apopka, FL 32703 Phone: 407-788-6888 Email: info@apopkasmiles.com Hours: Monday–Thursday 8:00 a.m.–4:00 p.m.; Friday 8:00 a.m.–2:00 p.m.; closed Saturday and Sunday

Frequently Asked Questions

Do I have to fill out forms before my visit?

It's not required, but completing them ahead of time saves time at your appointment.

What if I can't print the forms?

Call our office. We can provide forms when you arrive.

Do I need new forms if I'm a returning patient?

If your health, medications or insurance have changed, let us know so we can update your records.

Is my information kept private?

Yes. Your personal and health information is handled in line with our Privacy Policy. Call our office if you have questions about how your information is used.

Can I email my completed forms?

Call our office at 407-788-6888 to ask about the best way to send your completed forms before your visit.

Need help with your forms? Call Apopka Smiles at 407-788-6888.

Call us today 407-788-6888