New Dental Patients - Racine Dental Clinic

Our patient registration forms can be found at the bottom of the page. You can print and fill them out prior to your visit or fill them out when you arrive at Racine Dentistry for your appointment. The adult health history form is for patients 13 years and older and the child health history is for patients under 13 years old. Copies of our account registration form and privacy forms are also provided below.

Please arrive 15 minutes before your scheduled appointment time for your first visit to fill out any required forms.

New Patient Form

Medication List

Privacy Practices Form

Disclosure of Health Info

Payment Policy