Patient Forms

To save time, we suggest that you download and print any of these applicable forms prior to your new patient appointment:

Intake Forms

Step 1
Click on the form links above to download each PDF form
Print the forms
Step 2
Print the PDF form
Fill in the forms
Step 3
Fill in the required information
Scan and email the forms
Step 4
Scan and email us the completed form to the appropriate address below or simply bring the completed form in with your for your first appointment.

Email: fort@victoriadentist.com

Please note: these forms cannot be submitted online. To submit, please follow one of the options outlined above.

Thinking About Joining Us?

Offering the best outcomes in a friendly and warm atmosphere is our top priority. Our extremely knowledgeable, devoted team takes pride in providing customized care to each of our clients and a full range of services from basic preventative care and maintenance to braces and cosmetic treatments.

As a new patient, we will review your medical and dental history, all necessary x-rays and intraoral images, perform an oral cancer screening and gum health examination, as well as an examination of your teeth and soft tissues. Following the examination, we will discuss our findings with you, establish a treatment plan that you are comfortable with, and schedule your care accordingly.

If you have dental insurance, please come with your information and please be aware of your coverage. Payment is expected at the time of service unless previous plans are made. As a courtesy, we will file claims on your behalf with your dental insurance coverage company.

We kindly ask that you keep your consultations and appointments. Missing a visit interrupts appropriate sequencing of care and delays conclusion of your treatment. If you have to reschedule your consultation, we ask that you please provide us with 48 hours notice, as a courtesy. Whether you require a routine check-up or more extensive dental work, you can trust our dentist in Victoria to provide you with the highest quality care tailored to your needs.