"General & Advanced Dentistry"

(409) 224-8197

From A Patient

"My experiences with dentists have always caused me extreme fear. It is an area of my life that I have always struggled with and has hindered my ability to make wise choices. But my experience today has given me hope that I can overcome my fear. Root canal can be a positive and not a negative. Thanks to Dr. Koch and his wonderful team I can enjoy a healthy happy smile."

Anonymous

more testimonies and reviews

Payments

 

Patient Name:

 

 

Recommend Us

    

Associations

tda
Texas Dental Association

ada
American Dental Association

aaid
American Academy
of Implant Dentistry

cc
Crown Council

patient-forms

Complete Your Patient Forms

Online, Print, or At Our Office

For your convenience, Advanced Dental Care offers three ways to complete your patient information.

break

Dental Office Jasper in Southeast Texas

Complete Your Patient Forms Online

We Offer A Few Ways to Complete Your Patient Information Form

 

Online

We are pleased to offer you the convenience of completing and securely submitting your patient information online. Form can be completed from Smartphones, tablets, as well as computers.

    Securely Submit Patient Information Online

Download, Print and Bring In To Our Office

You can also print the Patient Information Forms, complete and bring them in when you arrive for your appointment. Requires the free Adobe Acrobat Reader.

    Download & Print Patient Information Forms

At our office

Of course, you can still complete your Patient Information Forms at our office. Please arrive at least 15 minutes early for your appointment, to allow time for you to complete the forms.

 


 

TMD Temporomandibular Joint Disorder Forms

TMD Screening Consultation

TMD Head, Neck Pain Exam & Workup

 


 

Other Forms

Oral Surgery & Implant Form

Periodontal Questionaire & Form

Orthodontic Questionaire & Form