Fort Smith Dentist - Patient Forms

1501 South Waldron Road, Suite 208, Fort Smith, AR 72903

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(479) 452-2994

(866) UCANSMILE (822-6764)

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Patient Forms

For your convenience, we have supplied a Health History Form in pdf format. If you wish, click on the link below, print, complete the form at home, and bring it with you to your first visit! We look forward to greeting you!

New Patient Forms Adult

New Patient Forms Child

Online Patient Registration

Summer Specials

VENEERS:
10% Off

DENTURES:
$100.00 Off

TEETH WHITENING KIT-
UPPER AND LOWER
TAKE HOME BLEACH TRAYS:
$150.00

Special Offers

NEW PATIENTS:
$50.00 Off Initial Exam
Good for First Visit

EMERGENCY PATIENTS:
$25.00 Off First Visit

EXISTING PATIENTS:
$25.00 Off Treatment

Offer expires: 02/04/2012

Summer Specials
<div style="text-align: center;">VENEERS: 
10% Off 
 
DENTURES: 
$100.00 Off 
 
TEETH WHITENING KIT- 
UPPER AND LOWER  
TAKE HOME BLEACH TRAYS: 
$150.00</div>
Special Offers
NEW PATIENTS: 
$50.00 Off Initial Exam 
Good for First Visit
EMERGENCY PATIENTS: 
$25.00 Off First Visit
EXISTING PATIENTS: 
$25.00 Off Treatment
Offer expires: 02/04/2012

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Fort Smith Dentist · Dr Phillips · 1501 South Waldron Road, Suite 208 · Fort Smith, AR · 72903