New Patients

New Patients- Forms Must Be Filled Out And Insurance Verified Before First Visit

New Patient Forms

Your first visit to Summerland Dental establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor.

To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies, and more. There's also background information about our committed staff and our first visit procedures. You can even save some time on your first visit by printing out and completing the patient forms before your appointment.

New Patient Appointment Scheduling Procedure

  • Step 1: At our dental clinic, we value your health and comfort above all else. That's why we kindly request you to fill out our forms - the new patient form, medical history (included in new patient form), healthy mouth assessment, and no-show policy. This initial step is crucial in ensuring that we have all the necessary information to provide you with the best care possible. After submission of these forms, we will verify your insurance coverage before proceeding further.
  • Step 2: Following the successful acceptance of your insurance plan at our clinic, one of our friendly staff members will reach out via phone call to schedule your first appointment with us.

New Patient Forms Healthy Mouth Assessment Form

Mission Statement

Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

    • Listening to those we are privileged to serve.
    • Earning the trust and respect of patients, profession, and community.
    • Exceeding your expectations.
    • Ensuring a creative, challenging, and compassionate professional environment.
    • Striving for continuous improvement at all levels.

Patient Forms


Save time and complete this form prior to your first visit toour office.

You will be asked to provide an office code to enter the site, which is listed below. Click on the Patient Registration button, complete and submit it, and then do the same for the Medical History. Be sure to complete all pages of the history. The form is complete when the send button appears at the end of the questionnaire. Be sure to answer EVERY question or you will be asked to complete the form once you arrive at the office.

We will text you a reminder of your appointment 1 day prior.

**Please contact your prior dentist and request all X-rays and treatment records be sent to us PRIOR to your initial visit. Please ask them to e-mail all records to:

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Summerland Key, FL

24986 Overseas Hwy, Summerland Key, FL 33042


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Office Hours

  • MON - WED8:00 am - 5:00 pm
  • THU8:00 am - 4:00 pm
  • FRI - SUNClosed
(305) 745-1522