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Document Centerdenzingercare2023-01-04T21:41:05+00:00

Document Center

New Patient Packet Online Forms

New Patient Packet (All Forms Required For New Patients)

Individual Online Forms

Patient Information Form
Medical History Form
Periodontal Risk Assessment Form
Notice of Privacy Practices Form
Financial Policy Form
Sleep Disorder Evaluation Form

Printable Forms

If you prefer to print your forms and complete them on paper, click the links below to download PDF forms. Once completed, bring them with you for your appointment.

  • Adult Patient Questionnaire Form (PDF)
  • Child Patient Questionnaire Form (PDF)
  • Medical History Form  (PDF)
  • Periodontal Risk Assessment Form (PDF)
  • Notice of Privacy Practices (PDF)
  • Privacy Practices Receipt (PDF)
  • Financial Policy (PDF)
  • Adult Sleep Disorder Evaluation Form (PDF)

Ask Us About

MyCare Dental Plan
  • First Visit
  • Common Dental Problems
  • FAQs
  • Document Center
  • Policies and Procedures
  • Emergency Info

Denzinger Family Dentistry – New Albany

5104 Charlestown Rd
New Albany, IN 47150
Phone: 812-941-1400

Monday8:00 AM - 5:00 PM
Tuesday8:00 AM - 5:00 PM
Wednesday8:00 AM - 5:00 PM
Thursday8:00 AM - 5:00 PM
Friday8:00 AM - 5:00 PM
SaturdayClosed
SundayClosed

Denzinger Family Dentistry – Jeffersonville

5520 Highway 62
Jeffersonville, IN 47130
Phone: 812-280-8000

Monday8:00 AM - 5:00 PM
Tuesday8:00 AM - 5:00 PM
Wednesday8:00 AM - 5:00 PM
Thursday8:00 AM - 5:00 PM
Friday8:00 AM - 5:00 PM
SaturdayClosed
SundayClosed

Denzinger Family Dentistry – Veterans Parkway

4100 Woehrle Road
Jeffersonville, IN 47130
Phone: 812-280-7500

Monday8:00 AM - 5:00 PM
Tuesday8:00 AM - 5:00 PM
Wednesday8:00 AM - 5:00 PM
Thursday8:00 AM - 5:00 PM
Friday8:00 AM - 5:00 PM
SaturdayClosed
SundayClosed

Document Center

Financing Available:

MyCare Dental Plan

Care Credit Financing

Online Bill Payment
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