patient forms

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Please help us be prepared for your appointment whether you're new to our practice or it's just been a while since we've seen you, by completing this Patient Information and Medical History form.  Download the form below to your computer, print it out, complete the form, and bring it with you to your first appointment. If you prefer to save a tree & not worry about leaving it on the kitchen counter, you can also email it to us and we'll have it ready & waiting for your signature at your next appointment! 


**The form is a MS Word document and will open as "read-only." To make changes to it, simply save it to your computer and once completed, email or print it.

Your First Visit!

First of all, thank you for choosing us to take care of your dental needs! Your first visit to the doctor typically includes an x-ray that allows the doctor to view the structure of the jaw, the position of any teeth that have not yet erupted, malformed roots, and tooth decay.The initial visit also involves getting your medical history. When you share your medical history with the doctor, be sure to provide complete, up-to-date information on your health. Inform your doctor if you have experienced recent hospitalization or surgery, or if you have recently been ill. Also tell the doctor the names, doses, and frequency of any medications you are taking — whether prescription or over-the-counter products — and the name of your physician. Inform the doctor of any changes in your health or medications. This information will help the doctor to select the most safe and effective method of treatment for you.

201 5th Ave. W. Springfield TN 37172 US

615.384.2659


Legal Stuff:

For those of you who enjoy this type of "legalese"- read away! Otherwise this is us being compliant & staying up to date on all that's important!


regular checkups!

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We encourage regular checkups for individuals age four and up. We treat all ages so it is convenient to schedule appointments for the entire family on the same day. Most people find that it is valuable to have a checkup and cleaning at least every six months.  Regular checkups include a thorough cleaning and an oral exam by your doctor. During the oral exam, your doctor checks the health of your mouth – teeth, gums, cheeks, and tongue. At each visit your doctor also checks old fillings and restorations because constant pressure from chewing, grinding, or clenching can cause them to wear away, chip, or crack.

Springfield family dental

Privacy Policy

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We take your privacy seriously. For all of you who enjoy reading legal gargon, then click to ready our full policy. For those of you who have no interest, it's ok. Just know your info, history and email address are safe with us! Plus we will be happy to give you a copy when your visit the office.