Cosmetic & Restorative Dentistry - Lawrence & Kansas City, Kansas KS Cosmetic & Restorative Dentistry - Lawrence & Kansas City, Kansas KS Cosmetic & Restorative Dentistry - Lawrence & Kansas City, Kansas KS
Cosmetic & Restorative Dentistry - Lawrence & Kansas City, Kansas KS


 

Use Our Convenient New Patient
Form For Your Dental Appointment...


For your convenience, we have made our new patient forms available in easy to use digital format (Adobe Acrobat PDF file).

Directions:

  1. Using our new patient form is as simple as printing and completing them at your home.

     
  2. When you're done, please bring your completed form with you for your first appointment.

     
  3. If you have any problems or questions, please call us or e-mail our office and we will gladly assist you.

Click Here To Download Your New Patient Form

Click on the image to download and print the PDF file.
Please fill out both pages for each new patient




Click to download Adobe Acrobat Reader.



 
 


Our Dental Practice Is Now Expanding And Accepting New Patients

Get A Free $25 Gift For Helping Us "Spread The Word!"

Give your friends and associates a free gift  - and we'll give you a $25 gift certificate. 
Click Here...

 
 
 
 


545 Columbia Drive Lawrence, Kansas 66049
Phone: 785.841.4840 | Fax: 785.841.5750
Email: kathd@lesmillerdds.com | www.lesmillerdds.com

785.841.4840

 
 
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