Chickasaw: 251-456-8406 | Midtown: 251-471-1516 | Eastern Shore: 251-300-6100

New Patient Forms

Help Us Get To Know You!

Please take a moment and fill out our patient intake form. Download and print the pdf's from the links below and bring the forms with you to your first visit. If you are unable to fill these forms before your first visit please arrive 20 minutes early to your appointment. If you have any questions, feel free to contact our practice.

  1. Azalea City Dental's Five Levels of Dental Care

  2. Welcome to Azalea City Dental

  3. Health History

  4. Financial Policies

  5. Notice of Privacy Practice

We also suggest learning more about our privacy policies and your rights by clicking here.