Patient Forms

Please click on the following links to download our forms.

To save the file on your computer: Right click on the link, then select “Save Target As”, choose a location on your computer then click “Save”

SF Patient Registration

icon_adobe_reader1 Patient CenterThese forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.

First Visit

Howard-John-Pic1 Patient CenterYour first visit to Smiles 4 Fairfaxinvolves a few special steps so that we can get to know you. Please be prepared to fill out several forms, which will provide us with pertinent information for your treatment. We will reserve approximatelyone and a half hours for your initial comprehensive exam. An assessment will also be provided which will outline your existing dental problems and treatment options. In most cases, providing that you do not have any signs of gum disease, we will also clean your teeth on this visit.

We realize most patients are anxious about dental care. Several relaxation techniques are used including oral sedation, nitrous oxide sedation (laughing gas) and TV monitors to make your visitmore comfortable. Remember that preventive dentistry is the lowest cost, and it is the most convenient way to retain your smile.

We want you to enjoy the benefits of strong healthy teeth. Thorough examination and prevention are the best ways to keep your mouth healthy and your smile beautiful. After a complete evaluation, you will be scheduled for the appropriate treatment with your dentist or hygienist.

Your first visit will include:

  • A review of your medical history, review of your dental history, blood
    pressure, allergies, and any medications you may be taking
  • Dental X-rays if necessary (if you have existing X-rays, please bring them with
    you to the initial appointment)
  • A check for oral cancer and jaw function
  • A check for decay and gum disease
  • We will take the time to come up with the most conservative treatment and
    discuss your personalized treatment options with you