Please take a moment and Right Click each document below to Save and Print. We request that you fill out our Patient History Form before your next visit if you are able.

Feel free to call our office at 304-329-1989 if you have any questions.

 

PDC Health History-1

PDC Health History-2

 

Please take a moment and Right Click below to Save and Print our Financial Agreement. We request that you read and sign it before your next visit.

Feel free to call our office at 304-329-1989 if you have any questions.

We are pleased to care for your dental needs.  This agreement is is part of our commitment to work with you on the financial aspects regarding the care you receive at our office.  We provide this agreement to avoid any misunderstanding or disagreement concerning payment for services rendered at our office.

Financial Agreement