accessibility ACCESSIBILITY

We look forward to meeting you. For your ease and convenience and to ensure that you are seen at your scheduled time we ask that you complete these forms and bring them to your appointment.

1. Print forms and bring them to your appointment

2. Fax them  to (262)691-9871
 
3. Email the forms to info@pewaukeedental.com

New Patient Adult Registration

New Patient Child Registration

New Patient HIPAA Form

New Patient Financial Options and Arrangements

How to Prepare Your Child for a Filling

HIPAA Notice of Privacy Practices

Acknowledgement of Privacy Practice

 


In-Office Whitening Consent Form

In-Office Whitening Instructions Before your Appoinment

In-Office Whitening instructions for after your appointment/ Menu for the first 48 hours

  

FREE!
Dr. Mike pays the INTEREST for 12 months 

Healthy Lives Need Healthy Smiles
You Deserve A Healthy Mouth!