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New Patient Online Forms 

Forms Image

Advance Dental offers our patients online forms so they can be completed in the convenience of your own home or office.

Follow these easy three steps:

  1. If you do not already have AdobeReader® installed on your computer, Click Here to download.
  2. Download the necessary forms below, print it out and fill in the required information.
  3. Bring them to your appointment.

By filling out these forms, we are able to know the history and current state of your dental and overall health. We are also able to assist with any questions, concerns or goals regarding dental care.

New Dental Patient Forms:

1. New Patient Registration

2. Medical History

3. Consent for Treatment

4. HIPPA Privacy Practices (Privacy Practice Policy is available for review in our office)

5. Financial Authorization

Appointment Policy - Updated (Please Review)


Download the Free AdobeReader®

EMERGENCY CARE
New Patient Emergency Exam and X-ray for $149

Request an appointment with Dr. Stangebye using the form below or contact us at 574-271-9910

THIS ---->https://advancedentalmichiana.dentalmatrixbase.com/contact-us/online-forms.html

Office Hours

DayMorningAfternoon
Monday8:00am4:00pm
Tuesday11:00am6:00pm
Wednesday9:00am5:00pm
Thursday9:00am3:00pm
Friday8:00am4:00pm
SaturdayBy Appt.By Appt.
SundayClosedClosed
Day Morning Afternoon
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8:00am 11:00am 9:00am 9:00am 8:00am By Appt. Closed
4:00pm 6:00pm 5:00pm 3:00pm 4:00pm By Appt. Closed

Adjusted Office Hours:  Closed - Thursday Nov. 23 and Friday Nov. 24, Monday December 25, Tuesday December 26, Monday January 1 & Tuesday January 2
Friday Availability: December 8 & 22, January 19 & 26, February 2 & 16
Saturday Availability: December 2, January 13, February 10
Upcoming Kid's Days: February 21, March 14, May 9, July 18

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