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New Patient Forms and Online Forms

Forms Image

Advance Dental offers our patient form(s) online so they can be completed it in the convenience of your own home or office. Follow these easy three steps:

  • If you do not already have AdobeReader® installed on your computer, Click Here to download.
  • Download the necessary form(s), print it out and fill in the required information.
  • Bring them with you to your appointment.

New Dental Patient Form - Required

This lets us know the history and current state of your dental health. What questions, concerns, goals, regarding dental care can we help you with? Let us know!

Appointment Policy - Updated *Please review

New Patient Registration

Medical History

Consent for Treatment

HIPPA Privacy Practices

Financial Authorization


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/online-forms1.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 - 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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