New Patient Information
We're thrilled to welcome you. Download your forms below, complete them before your visit, and arrive knowing exactly what to expect.
What to Expect on Your First Visit
Your first appointment is dedicated entirely to you — no rushing, no pressure. We allocate extra time for new patients so Dr. Al-Douri and our team can truly understand your oral health history, goals, and any concerns you may have.
Comprehensive Oral Exam
Thorough examination of teeth, gums, bite, and soft tissues — including an oral cancer screening.
Digital X-Rays
Low-radiation digital radiographs to reveal hidden decay, bone loss, and issues not visible to the naked eye.
Periodontal Assessment
We measure gum pocket depths and check for early signs of gum disease — one of the most under-diagnosed conditions in America.
Your Custom Treatment Plan
If any treatment is needed, we walk you through a clear, transparent plan — procedure by procedure, with costs — before anything begins.
Please arrive 15 minutes early for your first appointment to allow time to complete any remaining paperwork. Downloading and completing the forms below in advance will help your visit start on time.
Schedule Your First Visit
Call either of our locations or book online — we'd love to hear from you.
Patient Intake Forms
Download, print, and complete all four forms before your first visit to make check-in fast and seamless.
New Patient Registration
Start here — required for all new patients
Collects your basic personal information, contact details, address, emergency contact, and work information. This is the foundation of your patient record.
- Full name, preferred name, date of birth
- Mobile, home, and work phone numbers
- Email and mailing address
- Emergency contact name and relationship
- Employer and occupation
- Referral source
Health History
Medical background & conditions
A comprehensive medical history form that helps our team provide the safest, most appropriate dental care for your specific health situation. Please complete this honestly and thoroughly.
- Current physician and last physical exam date
- Current or past hospitalizations
- Pregnancy or breastfeeding status
- Tobacco and alcohol use
- Medical conditions (heart, lungs, neurological, autoimmune, etc.)
- Current medications and supplements
- Known allergies
Dental History
Your past dental experiences
Gives our team a clear picture of your dental background, preferences, and any immediate concerns you'd like us to address on your first visit.
- Previous dentist and last exam/cleaning dates
- Immediate concerns or areas of pain
- Comfort preferences and anxiety level (1–5 scale)
- Sensitivity, grinding, clenching, and TMJ history
- Gum disease, braces, or orthodontic history
- Questions about your bite, recession, and oral habits
Insurance Information
Primary & secondary dental insurance
Helps our billing team verify your benefits and maximize your coverage before your visit. Having this ready speeds up check-in significantly.
- Primary insurance carrier and ID/Group number
- Policy holder's name, date of birth, and employer
- Policy holder's address and contact information
- Secondary insurance details (if applicable)
- Insurance company phone number
Prefer to fill out forms at the office? Please arrive 15 minutes before your scheduled appointment time. Our front desk team will be happy to assist you.
Office Policies
We believe in full transparency. Please read these policies before your first visit.
Full policy documents are included in the New Patient Registration form PDF.
Insurance & Financing
Quality care should never be out of reach. We work with most major insurance plans and offer flexible payment options.
Insurance Accepted
We are in-network with many major PPO dental insurance plans. Our knowledgeable staff files claims on your behalf and helps you understand your coverage and estimated out-of-pocket costs before treatment begins.
AmeritasLiberty DentalDelta DentalCignaMetLife+ MoreDon't see your plan? Call us — we likely accept it. We verify benefits before your appointment at no charge.
Flexible Financing
No insurance? No problem. We offer multiple financing options so you never have to put off the dental care you need.
- CareCredit — 0% interest financing available
- In-house membership plans for uninsured patients
- All major credit cards accepted
- Payment plans available — ask our team
- Estimates provided before all treatment
Ready to Join the Reform Dentistry Family?
Download your forms, then give us a call or send a message to book your comprehensive new patient exam. We can't wait to meet you.
Or send us a message online →