"The very best in dentistry"

Dr. Bell's Dental Centers

Medical History Form

 

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Medical History Form
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Tip

 

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

  

Payment Plans also available.

Call Dental Fee Plan by Capital One

 1-888-337-4171

 or go online to to apply

Capital One Healthcare Finance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 your form to us at:

 

Fax Numbers:

Pinellas Park Location  (727)546-4602

Tyrone Location            (727)341-0803

 

CLICK HERE to download our Medical History Form

CLICK HERE to download our Privacy Practices

 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.

 

Copyright © 2003    Dr. Bell's Dental Center of Florida, PA.    All rights reserved.