Patient Forms

Please feel free to download the forms below to bring with you on your first appointment.

View our HIPAA Patient Privacy Policy.

TEXT OUR OFFICE

Text message is limited to 1000 characters.

I consent to allow Create A Smile Dentistry - Dr. Ken Moore to send text messages to my wireless phone number. Message frequency may vary. I understand I may opt-out at any time by replying "Stop".

HOW IT WORKS

  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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