Patient Forms

If you are a new patient to our office, the links below contain our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them upon your arrival.  If you do not have the capability to print these forms at home, please plan to arrive to your scheduled appointment at least 15 minutes early, to allow time for registration.  Thank you and please call our office if you have any questions at all.

*The 'Release of Records' form ONLY needs to be filled out if you are requesting to have your records transferred from your PREVIOUS dentist.  

New Patient Registration
Release of Records   
Informed Consent

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.


Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
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Smiles by Design, PLC | 1525 E Beltline Ave NE, #202, Grand Rapids, Michigan 49525

Phone: (616) 361-6161