New Patient Forms
Download and print your new patient health record, financial policy and health information consent. Bring completed forms to your West Melbourne Dentist appointment.
Download, print and bring your forms
Please download, print, and complete these forms before your appointment. Bring your completed forms with you to our office.
There are three printable PDF documents. The health record has two pages; the other documents each have one. Print on US Letter paper.
Your privacy
Do not email or upload completed medical forms. Please contact our office for assistance with securely transferring dental records. If you need help, do not have a printer or need an accessible format, call the office to discuss your options.
Office details
West Melbourne Dentist · Dr. John T. Bailey, DMD · 917 South Wickham Road, West Melbourne, FL 32904.
Monday, Wednesday and Thursday: 8:00 am–5:00 pm. Tuesday: 12:30 pm–7:30 pm.
Call (321) 723-0938 · Explore dental services · New patient forms