Gentle Dental Care Dr. Sells and Dr. Prather
1301 Olive Street, Benton, KY 42025
(270) 527-1479
Gentle Dental care in Benton KY Dr. Sells
New Patient Forms

FormThe New Patient Form is in Adobe Acrobat (PDF) format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. The Acknowledgement form does not require the reader and will open in a new browser window.

Please print the New Patient Form, fill it out, and bring it with you for your appointment. Also, after reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it, and bring it in, too.

 

Adobe PDFAdobe ReaderNew Patient Form (Acrobat PDF form)


Acknowledgement of Receipt of Notice of Privacy Practices (web page)