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Patient Forms


Our forms are provided below for your convenience.  Please print them, fill them out, and bring them with you to your appointment.  This will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our dental office if you have any questions or need any assistance. 

New Patient Medical History Form (2pages)

new patient form page 1.pdf

new patient form page 2.pdf

Health History Form Update
health history update form.docx


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

Crooked Creek Family Dental
Creating Beautiful Smiles

Jasper, Indiana Dentists Dr. Ross Flannagan and Dr. Kelly Young of Crooked Creek Family Dental offer general, restorative & cosmetic dentistry and provide services that include: dental cleanings & exams, crowns, dental fillings, teeth whitening,root canal therapy, dental fillings, family dentistry, senior dentistry, periodontal treatments, dental bridges & partial dentures. Contact our Jasper dental office today to schedule your appointment.

2021

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Our Office

2005 Saint Charles St.Jasper, IN 47546Get Directions(812) 482-4321

2021

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