405 Hogan Lane - Suite 2       501-329-1994     Conway, Arkansas  72034

Digita l X-ray is now available at Dr. Ellis' office                                        Reduces Radiation by 80%                                                 Environmentally Friendly                                             Instant Images mean faster appointment times

New Patient Forms

Tired of filling out those tiresome forms at the dentist's office?

New patients are encouraged to download the following forms to fill out before they get to the office. You can walk in and just hand the form to the receptionist.
This can dramatically help reduce your wait time by having the forms filled out before you arrive!

Click below for the five forms you will need:

Form #1 - Dental Registration & History

Form #2 - Insurance & Financing Form

Form #3 - Privacy Practices (1)

Form #4 - Privacy Practices (2)

Form #5 - Privacy Practices (3)

You will need to have the Adobe Acrobat Reader installed on your computer to print out these forms. The download is free and is the major form of document viewing and printing for the computer world. Click the icon below to download the reader if you don't already have it installed.