New Patient Forms

Home New Patient Forms
There are multiple ways to complete the ‘New Patient Form’.  It can be downloaded and saved to your computer and then emailed back to us.  Or it can be printed out and mailed, faxed, or brought to us in person. 
New Patient Form

1. By fax to: (928) 445-3268
2. By mail to: 3765 Crossings Drive, Suite A, Prescott, AZ 86305
3. By e-mail to: prescottsmilecare@cableone.net
4. In person: Simply bring it with you when you make your first visit.

Financial and X-Ray Policies

Download here: Policies Form

Payment Options

We accept cash, check, Visa, Mastercard, Discover, and CareCredit.

To learn more about CareCredit, please visit their website at www.carecredit.com or call them at (800) 365-8295.

Due to COVID-19 and the recommendations from the American Dental Association, Prescott Smile Care has temporarily closed the office except for emergencies. If you have a dental emergency and are a patient of record, please contact the office at 928-445-8503 as we will continue to see emergencies. If you are a new patient, please contact us and we will follow up once we are able to open again.