Forms

We are happy to offer our forms and applications for download.  Please feel free to print these and fill them out at your convenience before your visit.  Please do not email these forms over the Internet.

Health History (2 pages)

This form needs to be filled out before your first dental appointment.
Click here to download (792KB)

HIPAA Form

This form acknowledges that you have read the "Notice of Privacy Practices" below.
Click here to download (341KB)

Notice of Privacy Practices

This document is for your general information as required by federal HIPAA laws.
Click here to download (1.3MB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

Laurie Deemer, DMD
2104 Newton Drive, NE
Covington, GA 30014
Get Directions
 
Phone: (770) 787-2828
Fax: (770) 786-2167
 
Office Hours:

Mon 8:00am - 5:00pm
Tues 8:00am - 5:00pm
Wed 8:00am - 5:00pm
Thur 8:00am - 5:00pm