Patient Forms

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

Adult New Patient Forms

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

Adult Update Forms

  • Health History PDF
  • Patient Information PDF

Child New Patient Forms

  • Child Dental History PDF
  • Child Patient Information PDF
  • Office and Financial Policy PDF
  • Notice of Privacy Practices PDF

Child Update Forms

  • Child Dental History PDF
  • Child Patient Information PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

(937) 293-0757
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.