Patient Forms

Please take a minute to print and fill out the patient information forms before your first appointment.

Patient Information
Health History
Notice of Privacy Practices and Patient Consent
Office and Financial Policy

(937) 253-9115

1950 S Smithville Rd
Kettering, OH 45420

*Please be advised that Van Buren Dental is located 2 blocks south of Patterson Road in *KETTERING*, 45420, not Dayton. There is a 1950 S. Smithville in Dayton but the address changes again when you hit Kettering. Please note this while inputting into a GPS or driving down S. Smithville.