972-252-3020 Before your first visit with our dentist, please fill out our patient forms so we can have the information we need to best care for you and your smile. If you have any questions about our forms or would like to schedule an appointment with Dr. Keith Mitchell, please call our office today at 972-252-3020 and learn more about dental care in Irving, Texas.
Download & Print Forms
HIPAA FORM
PATIENT INFO RELEASE
Assignment of Benefits Form
Consent for Fillings
Consent for Night Guard/Occlusal Guard
CONSENT FOR CROWN AND BRIDGE PROSTHETICS
CONSENT FOR FULL AND PARTIAL DENTURES
CONSENT FOR ORAL SURGERY
Consent for Recontouring (Odontoplasty)
Consent for Dentures at Wax Try-In
CONSENT FOR ZOOM WHITENING
CONSENT FOR PERIODONTAL SCALING AND ROOT PLANING
Occlusal Guard Refusal
Periodontal Disease Refusal