Please print, complete and sign each of the forms below. Bring the completed forms with you to your first dental visit in Marietta, Georgia. If you cannot complete these forms ahead of time, please arrive 15 minutes early for your first appointment. (We can provide you a copy of the forms when you arrive.) Also, remember to bring a valid picture ID (such as a driver’s license) and a copy of your insurance card. Also remember to check the information on the Financial Options page to make sure your insurance will work at Georgia Dental Medicine. If you are coming in for a TMD treatment or jaw pain, fill out our Facial Problem and Trauma questionnaires.
Please remember that appointment times are reserved especially for you. If you are unable to keep your appointment, please call the office at least 24 hours in advance so that we may offer that time slot to another patient. A full schedule allows us to keep our fees as low as possible. Missed appointments increase our overhead costs and eventually your costs.
If you need emergency care, call 770-973-6494 and contact us during regular office hours. Our dentist in Marietta, Georgia, Dr. Christopher M. Anderson, will make every attempt to see you that same day. Please call early in the day so that we may accommodate you as soon as possible.
New Patient Online Forms
Authorization to Release Recent X Rays to our Office
New Patient Information
New Patient Medical Dental History
Patient Authorization to Release Info
Notice of Privacy Practices
Acknowledgement of Receipt of NPP
If you are coming in for a TMD treatment or jaw pain, fill out both the Facial Problem and Trauma questionnaires.