New Patients (330) 269-5805

Current Patients (330)-343-2555

541 Wabash Avenue Northwest New Philadelphia, OH 44663

New Philadelphia OH Dentist Office Patient Forms

For the convenience of our patients, we provide an online portal for filling out your new patient forms. Please fill out forms as thoroughly as possible so that we can provide you with the best possible care.

The links below will take you to our new patient forms which can be filled out electronically at your convenience and in the privacy of your own home. Once submitted, the information will be securely transmitted to our office which will allow us to prepare for your visit.

Our forms are compatible with any computer, laptop, tablet or smartphone!

Please allow around 20 minutes to provide the necessary information. Thank you!

If you have any questions, please reach out to our Insurance Coordinator, Keddi at (330) 269-5805 or email her, at and she will be happy to assist you.

Please click the correct link below to begin filling out forms for yourself or your child.

    • **For Child New Patient Forms Only**  Prior to filling out the forms it is CRITICALLY important to observe your child sleeping after he/she has been asleep for at least an hour 2-4 different times, for about 10-15 minutes each. For instance, if he/she goes to bed at 8:30pm, you could watch him/her at 9:30pm and 11:00pm. The next night, you could watch him/her at 10:00pm and 5:30am. Two times is minimum and four times is ideal. If you are only able to observe twice, please observe on two different nights, once in the pm and once in the am.  Please observe for the following things:
      • Snoring – how much?
      • Breathing – is it labored, difficult, loud?
      • Interrupted Breathing – does he/she stop breathing for 4 or more seconds at a time?
      • Mouth breathing –  does breathing ever occur through his/her mouth?
      • Sweating – is he/she sweaty while sleeping?
      • Talking in Sleep – does he/she ever talk during sleep?
      • Restless Sleep – does he/she move around, toss and turn?