..Medical History Form..

"Creating Brighter Smiles through Contemporary Dental Care"

..Medical History Form..

NOTE

For your convenience we accept Master Card, Visa & Discover Card.

Payment Plans also available.

Call Care Credit
(866) 893-7864

OR

Apply Online at CareCredit

SAVE VALUABLE TIME !

To make your initial appointment easier, you may download our medical history to fill out prior to your appointment and bring it with you on your scheduled appointment. Please arrive 15 minutes prior to your appointment time so we may enter your information into our computer and/or verify your insurance. To further expedite your check-in experience, you can fax or email your completed forms to us at:

Fax Numbers:

Pinellas Park Location (727)546-4602 Email: info@exactdentistry.com

Tyrone Location (727)341-0803 Email: tyrone@exactdentistry.com

CLICK HERE to download our Medical History Form in .pdf format

CLICK HERE to download our Privacy Practices in in .pdf format

You must have Adobe Acrobat Reader installed on your computer. If you need to install Adobe Reader, please click on the Adobe image and you will be redirected to a website where you can download this program.

CLICK HERE to download our Medical History Form in MS_Word

CLICK HERE to download our Privacy Practices in MS_Word