Teeth Whitening Cosmetic Dentistry Dental Implants Invisalign CEREC Crowns More Services
 Teeth Whitening Porcelain Veneers Dental Impalnts Invisalign CEREC Same-Day Crowns We offer a full range of high-tech dental services.
For that special event! Smile makeovers! Replace missing teeth! Straight teeth, no braces! Beautiful smile, less time! High-tech dental services!

New Patients

Welcome! We look forward to seeing you!

Below, are the forms you will need to fill out before your first visit.

Download the forms to your computer.
Save them in a folder where you keep your important health documents.
Do not fill out these forms using your web browser.
 
Instead, use a stand-alone PDF reader such as
Adobe Acrobat Reader.


Fill  out your forms using your keyboard and mouse,  When you have completed the form(s), and saved them in your Health Records folder, simply attach them to an email and send to "amistaddentistry[*at*]amistaddentistry.com".

Or, you can print them, fill them out with a pen, and bring them with you to your first appointment.

New Patient Form

Medical History Form

Insurance Authorization and Financial Responsibility Form

Patient Privacy Form


Patient Records Transfer

Dental and medical providers may transfer patient information to us through our secure email system. Please send patient records, xrays, photos, sleep studies, labs, or other patient information to "amistaddentistry[*at*]amistaddentistry.com". We also subscribe to DropBox and will be happy to pick up patient files there as well. Send the link to share files to the email address above and we will pick them up directly.

Need an appointment? Have a question?

*Required Field
Your Name
*
Email Address (We will not share it, or sell it.)
*
Your Phone Number
*
I am a new patient.
I am a returning patient.

Describe the kind of work you'll need.
*
For security, please enter the number
"seven hundred seventy seven" *
 

Hours

Monday - Thursday: 8:30 - 5:00
Friday - 8:30 - 1:00

2223 Veterans Blvd.
Del Rio, Texas, 78840
Tel 830-742-0727
(Please dial area code!)

Fax (830) 775-7418

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