Patient Forms

If you are a new patient to our office, the links below contain our new patient forms ("New Patient Registration" and "Informed Consent") 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.  If you arrive late we reserve the right to limit treatment or reschedule your appointment, as everyone's time is valuable! Thank you and please call our office if you have any questions at all.

*The 'Release of Records' form is ONLY necessary if you are requesting to have your records transferred from your PREVIOUS Dentist, or if you are requesting to have your records transferred from Smiles by Design to a NEW Dentist of your choice.  

*For a copy of our HIPAA Privacy Practices, please click the link below.

New Patient Registration

Informed Consent

 

 

Release of Records

Notice of HIPAA Privacy Practices



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