Our patient forms have been made available online to download and fill out at your convenience. If you have any questions, don’t hesitate to give us a call at 270-683-0620, or email us using the contact form on this page.

Download — Patient Information (PDF)

Download — Dental & Medical History (PDF)

Download — Financial Guidelines (PDF)


Text message is limited to 160 characters.


  1. Enter your Name.
  2. Enter your Cell Phone Number, area code first
  3. Enter your text message in the box.
  4. Click "Send Text"
  5. A copy of this text will be sent to the office and to your cell phone. The office's reply will also be sent to your cell phone where you can continue the text conversation.
Note: Mobile message and data rates from your cell phone carrier may apply.Close ClickToCall Button
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