Chris leiszler DDS

Give Us a Call: (785) 594-9834

Family & Cosmetic Dentistry

patient smiling

Improve Your Smile

Patient Forms

Help us get to know you!

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

» Online Patient Forms

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

» Child Dental History Form [PDF]
» Child Medical History Form [PDF]
» Adult Dental History Form [PDF]
» Adult Medical History Form [PDF]

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

We look forward to meeting you at your first appointment.

 

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