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Patient's forms

For Patients 

During your first appointment, you will receive a comprehensive exam, a review your previous dental and medical histories and a cleaning if you do not have gum disease. If we find decay, damage, or gum disease the dentist will discuss the pros and cons of your dental options. And once you and he have
developed a course of treatment, the front office staff will provide an itemized estimate of your out-of-pocket fees based on the information provided by your insurance company.

 

Below you will find our New Patient's Forms that you will need to complete on your first visit. You can expedite matters by downloading the package, completing it at home and handing it to our staff when you arrive for your initial visit to our office.

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In order to view or print these forms you will need Adobe Acrobat Reader installed.

Patient Information Form
Medical Hx. Questionnaire
Payment Options
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Location: 347 W. Lincoln Trail Blvd.  #1                          Radcliff, KY 40160

Phone: (270) 351-3505

Email: cornettedmd@gmail.com

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OFFICE HOURS:

Mon-Thu: 8AM - 5:30PM

Fri, Sat & Sun: closed

©2022 Aesthetic Dental Center of Kentucky . Web Design by PIMM

Dentist | Cosmetic Dentist | Emergency Dentist

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