Chris leiszler DDS

Give Us a Call: (785) 594-9834

Family & Cosmetic Dentistry

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Patient Forms

Help us get to know you!

Please take a moment and fill out our patient information forms online. If you have any questions along the way, feel free to contact our practice.

 

» Adult New Patient Forms

» Child New Patient Forms

 

If you prefer, you may also print out the following forms and bring them with you during your first visit:

» Printable Insurance & Financial Policy [PDF]
» Printable Patient Information Form [PDF]
» Printable Adult Health History Form [PDF]
» Printable Child Health History Form [PDF]

(If you're unable to open PDF files, you can get Adobe Reader® for free.)

If you do not fill out your new patient forms in advance of you first appointment, please be sure to arrive at least 15 minutes early to allow time to complete them in the office.  We look forward to meeting you soon!

 

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