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Patient Forms

patient-forms

For your convenience, we have made our new patient forms available online. You can either print the Patient Registration form and bring it with you to your first appointment or click below to fill it out online. If you are printing the form, please also print out our Notice of Privacy Practice for review along with your New Patient Forms.

Complete Online:

Download and Print Documents:

Patient Registration Form

Notice of Privacy Practice

Privacy Practice Consent Form

Medical Update Form

Location & Hours

Our Location

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Hours of Operation

Our Regular Schedule

Primary Location

Monday:

8:00 am-5:00 pm

Tuesday:

8:00 am-5:00 pm

Wednesday:

8:00 am-5:00 pm

Thursday:

8:00 am-5:00 pm

Friday:

We are open the second and fourth Friday of the month from 8am – 1pm

Saturday:

Closed

Sunday:

Closed

Featured Articles

  • Your Rights and Responsibilities as a Patient

    Patient Rights You have a right to choose your own dentist and schedule an appointment in a timely manner. You have a right to know the education and training of your dentist and the dental care team. You have a right to arrange to see the dentist every time you receive dental treatment, subject to ...

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  • Crowns and Bridges

    Bridges Bridges are natural-looking dental appliances that can replace a section of missing teeth. Because they are custom-made, bridges are barely noticeable and can restore the natural contour of teeth as well as the proper bite relationship between upper and lower teeth.Bridges are sometimes referred ...

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  • Veneers

    Teeth that are badly stained, shaped, or crooked may be improved by a veneer placed on the surface of the affected teeth.Veneers are thin pieces of porcelain or plastic cemented over the front of your teeth to change their color or shape. Veneers are used on teeth with uneven surfaces or that are chipped, ...

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  • Invisalign®

    Invisalign's® invisible, removable, and comfortable aligners will give you the beautiful straight teeth you've always wanted. And best of all, no one can tell you're wearing them. Invisalign® is great for adults and teenagers. What is Invisalign®? Invisalign® is the invisible way to straighten your ...

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  • April 2022 Dental Newsletter

    The Importance of Preventive Care: Maintaining Good Oral Health Preventative dental care is a significant part of overall dental health, but it's often an afterthought. Our dedicated dentist sees many patients who don’t keep up with consistent preventative oral care and then must fix the problems ...

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  • Fillings

    Frequently asked questions: dental fillings Are dental amalgams safe? Is it possible to have an allergic reaction to amalgam? Is it true that dental amalgams have been banned in other countries? Is there a filling material that matches tooth color? If my tooth doesn't hurt and my filling is still in ...

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  • Sealants

    Sealants are liquid coatings that harden on the chewing surfaces of teeth and are showing a great deal of effectiveness in preventing cavities—even on teeth where decay has begun. The pits and grooves of your teeth are prime areas for opportunistic decay. Even regular brushing sometimes misses these ...

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  • Overview

    Pain can occur in any number of places in your mouth: teeth, gums, roots, the palate, tongue and jaw. Cavities are a common culprit causing pain. Untreated cavities can impact nerves because of infections of the tooth and gums. Impacted and abscessed teeth and sore jaws from teeth grinding are other ...

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  • Toothaches

    Simple toothaches can often be relieved by rinsing the mouth to clear it of debris and other matter. Sometimes, a toothache can be caused or aggravated by a piece of debris lodged between the tooth and another tooth. Avoid placing an aspirin between your tooth and gum to relieve pain, because the dissolving ...

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  • Scaling and Root Planing

    Some cases of acute periodontal (gum) disease that do not respond to more conventional treatment and self-care such as flossing may require a special kind of cleaning called scaling and root planing. The procedure begins with administration of a local anesthetic to reduce any discomfort. Then, a small ...

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Contact Us

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Testimonials

Testimonials

What Our Clients Say About Us

    I've been going to Dr. Cook for over 5 years now. He is very personable to all his patients as well as Candice one of the hygienists there! Never had a problem with any work he has done for me!

    Justin Beale

    I had an emergency and they fit me in the same day. They were so nice and caring. I highly recommend this office.

    Cindy Sutton

    I absolutely love this office!! Everyone is so friendly and efficient. I tell everyone who is looking for dental care to give you a call!

    Elizabeth N

    With a friendly staff, knowledgeable hygienists, the latest technology, and a dentist (i.e., Dr. Cook) who actually spends the time needed to make sure you are satisfied with the services provided, anyone in the area ought to consider Smithfield Family Dentistry when looking for dental services.

    Anonymous