Reviews Icon Pin Icon Appt Icon Phone Icon

We currently do not offer online fillable forms because they could allow erroneous or fraudulent requests for or use of patient information. Please print out the form(s) you need below and complete manually. You can fax the completed forms to our office (our fax number is 770-973-6544) or scan and email them to You can also US Mail them if you like, or if you prefer, you can just bring them to your next appointment. You may also complete the patient forms at our office if you arrive 15 minutes early for your appointment. Please 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.


If you are coming in for a TMD treatment or jaw pain, fill out both the Facial Problem and Trauma questionnaires.

Dr Referral Forms