Call La Crosse's Gentle Family Dentist at (608)782-5675

New Patient Admission Forms

If you are registering a new patient (yourself or for another person), please download and complete each of the forms below.

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New Patient Info Form

What next?

  1. Download the Form
  2. Print the form
  3. Complete the form manually
  4. Bring completed form with you to your first visit to expedite the admission process
  5. Please repeat the process for each person (spouse, child, etc.)

 

Dental History Form

What next?

  1. Download the Form
  2. Print the form
  3. Complete the form manually
  4. Bring completed form with you to your first visit to expedite the admission process
  5. Please repeat the process for each person (spouse, child, etc.)

 

Medical / Dental History Form

What next?

  1. Download the Form
  2. Print the form
  3. Complete the form manually
  4. Bring completed form with you to your first visit to expedite the admission process
  5. Please repeat the process for each person (spouse, child, etc.)

 

Schedule an Appointment

Or visit us at 1200 Main St. (Lower Level),  La Crosse, WI 54601 (see map below)

Call (608) 782-5675Send a Message

Stanek Dental

Stanek Dental
1200 Main St.
La Crosse, WI 54601

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