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Dr. John Kearns

Dr. Carol Cleaver

Dr. Michael Main

Call: (515) 287-2493

Patient Forms

If you are a new patient to our office, the file below (New Patient Forms) contains our new patient packet that we ask you to please print and fill out completely.  Please bring these completed patient forms and your dental insurance information (if applicable) to your first dental appointment.  Completing these forms in advance allows us to devote your appointment time to your dental needs.

We ask that all new patients arrive 15 minutes prior to their scheduled time.  If you have any questions, feel free to call us!  We look forward to seeing you at your appointment!

New Patient Forms 
Please save these to your computer, fill them out, print a copy for your records, then email the completed forms to our office

HIPPA - Read Only

Payment Policy - Read Only

Non-Discrimination Policy - Our policy compliance with sec-1557 of Patient Protection & Affordable Care Act

 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.

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