3150 N. Tenaya Way, Suite 570 • Las Vegas, NV 89128
phone 702-360-3030 • fax 702-360-2340

We have made our new patient forms available to you as Adobe Acrobat files. For your convenience, we recommend printing and completing these forms at home.

Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our office and we will gladly send or fax them to you.

Registration Form

Dental History Form

Medical History Form

Las Vegas Smile Makeover


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3150 N. Tenaya Way, Suite 570 • Las Vegas, NV 89128
phone 702-360-3030 • fax 702-360-2340

© 2003 Robert Van Dyke, D.D.S.
Site designed and maintained by TNT Dental