Prairie Lakes Dental

BECOME A NEW PATIENT

When you arrive for your first visit, please be prepared to complete all insurance and health information forms that will allow us to begin your dental treatment. We will ask you to fill out several forms that will get you acquainted with our office. If you’d like to get started with your paperwork, you can fill out and submit the form below.

Your initial exam will last approximately an hour and a half. Oral hygiene instructions will be provided along with suggestions to help you care for your teeth. In most cases, we will also clean your teeth on this visit and provide an evaluation that will outline your existing dental problems and proposed treatment.

Please complete the New Patient online form and submit it to us before your first appointment or print out the form and bring it with you.


  • Spouse Information


  • Dental Insurance


  • Dental History


  • Medical History

  • Although dental personnel primarily treat your mouth, your mouth is part of your entire body. Health problems that you may have, or medication that you may be taking, could have an important interrelationship with the dentistry you will receive. Thank you for answering the following questions.