Patient Forms

For Your First Visit

We are honored to be your dental provider! We realize filling out paperwork is time consuming; therefore, we have made every effort to minimize the paperwork required for our patients, while still obtaining the information we need to provide you with the highest quality service possible.

 

In order to make better use of your time at our office, we have provided you with the below registration forms. The forms included in this registration packet enable us to learn about your dental history and how it affects your overall health, track the effectiveness of any treatments you may receive, and accurately bill your insurance.  

 

**IMPORTANT** 
The forms must *FIRST* be downloaded and saved to your computer before editing electronically.  This is done by "mousing over" the right bottom corner of the page and clicking on the disk icon.  Once saved, forms can be filled in on your computer but must be re-saved with updates before attaching and emailing to us at accounting@kotredental.com.  The forms may also be printed at home and brought into the office at your next appointment. 

 

 

 *(view HIPAA Disclosure Documents)

**Please note that Google Chrome or Internet Explorer are required in order to fill out the forms online.

Ann Arbor Dentist, Dentist in Ann Arbor Michigan, Emergency Dentistry, Pediatric Dentistry
Engage With Us
  • Wix Facebook page
  • Pinterest App Icon
  • YouTube App Icon
  • LinkedIn App Icon
  • Twitter Classic
  • Google+ Social Icon

Shannon Norman-Kotre, DDS

Ann Arbor Dentist

 

2240 S. Huron Parkway
Ann Arbor, MI 48104

 

ph: 734-677-2156

Find Us

© 2019 by Shannon Eggleton