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North Pointe Dental Center
+1 (239) 997-9949

Patient Forms

Our patient forms let you finish your new patient registration before you arrive, so there’s less paperwork at check-in. Fill out the form online, or print the PDF version and fax it to (239) 997-0490 or bring it with you to your appointment.

New Patient
Registration Form
(PDF Version)

Download & Print Form

New Patient
Registration Form
(Online Version)

Fill Out Online

What the Registration Form Asks For

Having these details handy makes the form quick to complete:

  • Your contact details and date of birth
  • Your dental insurance company and group number, if you have coverage
  • Your dental history, including your former dentist and the dates of your last dental visit and X-rays
  • Your health history, current medications and allergies
  • An emergency contact who doesn’t live in your household

Call (239) 997-9949 with any questions about your forms, or request an appointment if you haven’t scheduled yet.

We’re open Monday through Thursday from 8 a.m. to 5 p.m.