DeWitt and Stuttgart AR dentists, Drs. Hestir and Allen
 
New Patient Forms
 

formThe New Patient Registration Form is in Adobe Acrobat (PDF) format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. The Acknowledgement form does not require the reader and will open in a new browser window.

Please print the New Patient Registration Form, fill it out, and bring it with you for your appointment.

Adobe PDFAdobe ReaderNew Patient Form

Adobe PDFMedical & Dental History Form

Adobe PDFPromise to Pay

Also, after reading the Notice of Privacy Practices, print the Privacy Consent form below, sign it, and bring it with you for your appointment: