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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®

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

SaturdayBy Appt.By Appt.
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 - Monday Sept. 4, Closed - Monday December 25 & Tuesday December 26
Friday Availability: August 18 & 25, September 15, 22 & 29, October 13 & 20, November 3 & 17, December 8 & 22, Jan 19
Saturday Availability: August 12, September 16, November 11, December 2, January 13, February 10
Upcoming Kid's Days: Wednesday July 12th from 1 to 7pm, Wednesday August 16th from 1 - 7pm, Wednesday Sept. 13th from 1 - 7pm


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