Your Name: NEW PATIENT REGISTRATION If you are a new patient, we ask that you provide information to establish your patient account and prepare for your first visit with us. Please arrive 20 to 30 minutes prior to your scheduled appointment time to complete the forms in our office. Or, to save time, simply print out each of the forms below, complete them and bring them along to your appointment. Adult Patient Information Child Patient Information Download Acrobat Reader Your E-mail Address: Your Telephone Number: Best day of the week: Monday Tuesday Wednesday Thursday Friday Best time of the day: Early Morning Late Morning Early Afternoon Late Afternoon Evening Preferred Location: New Albany Treatment Desired: Routine Cleaning Teeth Whitening Crown Oral Piercing Floride Do you have dental insurance? YesNo Insurance Company: Dental Insurance Plan: Group #: