Gentle Dentistry
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New Patients:
Mobile Number (813) 734-7102
Existing Patients:
Mobile Number (813) 972-3500

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Gentle Dentistry
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  • About Us
    • Meet Your Doctors
    • Meet Our Team
    • What Makes Us Different – Concierge Dental Wellness
    • What We Love About What We Do
    • Blog
    • Web Stories
  • New Patients
    • Your First Visit
    • Our Comfort Menu
    • New Patient Forms
    • Dental Savings Plan
    • Insurance Friendly
    • No Insurance? We Can Help!
    • Flexible Payment Options
  • Services
    • Complete Health Dentistry
    • How my mouth connects to
      • Cardiovascular Disease
      • Stroke
      • Alzheimer’s Disease
      • Diabetes
      • High Blood Pressure
      • Obstructive Sleep Apnea
      • Obesity
      • Colorectal Cancer
      • Lung Disease
      • Rheumatoid Arthritis
      • Osteoporosis
      • Kidney Disease
      • Pregnancy
    • Do you have these conditions
      • Missing Teeth
      • Tooth Pain
      • Broken Tooth
      • Jaw Pain (TMJ)
      • Teeth Grinding
      • Bad Bite
      • Stained Teeth
      • Bleeding Gums
      • Dry Mouth
      • Bad Breath
      • Snoring
      • Lost Filling or Crowns
    • Cosmetic Dentistry
      • Porcelain Veneers
      • Teeth Whitening
      • Dental Bonding
      • Invisalign
      • Porcelain Crowns
      • Composite Resin Veneers
      • Recession Treatment
    • General Dentistry
      • Dental Crowns
      • Dental Bridges
      • Composite Resin Fillings
      • Removable Partial Dentures
      • Removable Complete Dentures
    • Implant Dentistry
      • Implant Bridges
      • Implant Dentures
    • Restorative Dentistry
      • Tooth Colored Fillings
      • Dental Implants
      • Dentures
      • Full Mouth Reconstruction
      • Over Dentures
      • Implant Crowns
    • Preventive Dentistry
      • Oral Cancer Screenings
      • Oral Hygiene
      • Salivary Testing
      • Perioprotect Oxygen Therapy
        • Silver Diamine Fluoride
      • Home Care
        • Fluoride Trays
        • Oral Probiotics
        • Perioprotect Oxygen Therapy
      • Our Hygiene Program
        • Healthy Mouth Cleanings
        • Deep Cleanings (SRP)
        • Periodontal Maintenance Cleanings
    • Facial Aesthetics
      • Botox
      • Juvéderm
      • Facial Rejuvenation
    • Specialties
      • Endodontics (Root Canal Specialty)
        • Root Canal
        • Apicoectomy
        • Retreatment of Previous Root Canal
      • Periodontics (Gum & Bone Specialty)
        • Biological Shaping
        • Implant Surgical Placement
        • Recession Treatment
        • Bone Grafting
        • Extraction
        • Osseous Periodontal Therapy
        • Wisdom Teeth Removal
  • Reputation
  • Patient Center
    • New Patient Forms
    • Our Comfort Menu
    • Dental Savings Plan
    • Insurance Friendly
    • No Insurance? We Can Help!
    • Flexible Payment Options
    • Do We Refer Out and Why?
    • Post-Operative Forms
    • Pay My Bill
  • Smile Gallery
  • Contact Us
Mobile Number (813) 734-7102
Request an Appointment
New Patient Forms
Home » New Patient Forms

New Patient Forms

  • Please download the form by clicking the link below
  • Print the form
  • After completing the form, please bring it to your first appointment!
New patient registration form
Notice of Patient Privacy Practices

Healthy smiles for healthier lives by gentle dentistry

CTA - PhoneMobile Number (813) 734-7102
CTA - Map 3500 E. Fletcher Avenue – Suite #221
Tampa, FL 33613
CTA - Fax (727) 733-4568
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Office Hours

Monday :
7.00 am – 4.00 pm
Tuesday :
7.00 am – 4.00 pm
Wednesday :
7.00 am – 4.00 pm
Thursday :
7.00 am – 4.00 pm
Friday :
– CLOSED
Saturday :
– CLOSED
Sunday :
– CLOSED
  • Home
  • Call
  • Appointment
  • Treatments
  • Find us
  • Home
  • About Us
    • Meet Your Doctors
    • Meet Our Team
    • What Makes Us Different – Concierge Dental Wellness
    • Web Stories
    • Blog
    • What We Excel At
  • New Patients
    • Your First Visit
    • Our Comfort Menu
    • New Patient Forms
    • Join Gentle Dentistry’s In-House Dental Savings Plan
    • Insurance Friendly
    • No Insurance? We Can Help!
    • Flexible Payment Options
  • Services
    • Complete Health Dentistry
    • How my mouth connects to
      • Cardiovascular Disease
      • Stroke
      • Alzheimer’s Disease
      • Diabetes
      • High Blood Pressure
      • Obstructive Sleep Apnea
      • Obesity
      • Colorectal Cancer
      • Lung Disease
      • Rheumatoid Arthritis
      • Osteoporosis
      • Kidney Disease
      • Pregnancy
    • Do you have these conditions
      • Missing Teeth
      • Tooth Pain
      • Broken Tooth
      • Jaw Pain (TMJ)
      • Teeth Grinding
      • Bad Bite
      • Stained Teeth
      • Bleeding Gums
      • Dry Mouth
      • Bad Breath
      • Snoring
      • Lost Filling or Crowns
    • Cosmetic Dentistry
      • Porcelain Veneers
      • Teeth Whitening
      • Dental Bonding
      • Invisalign
      • Porcelain Crowns
      • Composite Resin Veneers
      • Recession Treatment
    • General Dentistry
      • Dental Crowns
      • Dental Bridges
      • Composite Resin Fillings
      • Removable Partial Dentures
      • Removable Complete Dentures
    • Implant Dentistry
      • Implant Bridges
      • Implant Dentures
    • Restorative Dentistry
      • Tooth Colored Fillings
      • Dental Implants
      • Dentures
      • Full Mouth Reconstruction
      • Over Dentures
      • Implant Crowns
    • Preventive Dentistry
      • Oral Cancer Screenings
      • Oral Hygiene
      • Salivary Testing
      • Perioprotect Oxygen Therapy
        • Silver Diamine Fluoride
      • Home Care
        • Fluoride Trays
        • Oral Probiotics
        • Perioprotect Oxygen Therapy
      • Our Hygiene Program
        • Healthy Mouth Cleanings
        • Deep Cleanings (SRP)
        • Periodontal Maintenance Cleanings
    • Facial Aesthetics
      • Botox
      • Juvéderm
      • Facial Rejuvenation
    • Specialties
      • Endodontics (Root Canal Specialty)
        • Root Canal
        • Apicoectomy
        • Retreatment of Previous Root Canal
      • Periodontics (Gum & Bone Specialty)
        • Biological Shaping
        • Implant Surgical Placement
        • Recession Treatment
        • Bone Grafting
        • Extraction
        • Osseous Periodontal Therapy
        • Wisdom Teeth Removal
  • Reputation
  • Patient Center
    • Your First Visit
    • Our Comfort Menu
    • New Patient Registration
    • Dental Savings Plan
    • Insurance Friendly
    • No Insurance? We Can Help!
    • Flexible Payment Options
    • DO WE REFER OUT AND WHY?
    • POST-OPERATIVE FORMS
  • Smile Gallery
  • Contact Us
  • Request an Appointment
  • Privacy Policy
  • Cookie Policy
  • Accessibility Statement
  • Complete Health Dentistry
  • How my mouth connects to
    • Cardiovascular Disease
    • Stroke
    • Alzheimer’s Disease
    • Diabetes
    • High Blood Pressure
    • Obstructive Sleep Apnea
    • Obesity
    • Colorectal Cancer
    • Lung Disease
    • Rheumatoid Arthritis
    • Osteoporosis
    • Kidney Disease
    • Pregnancy
  • Do you have these conditions
    • Missing Teeth
    • Tooth Pain
    • Broken Tooth
    • Jaw Pain (TMJ)
    • Teeth Grinding
    • Bad Bite
    • Stained Teeth
    • Bleeding Gums
    • Dry Mouth
    • Bad Breath
    • Snoring
    • Lost Filling or Crowns
  • Cosmetic Dentistry
    • Porcelain Veneers
    • Teeth Whitening
    • Dental Bonding
    • Invisalign
    • Porcelain Crowns
    • Composite Resin Veneers
    • Recession Treatment
  • General Dentistry
    • Dental Crowns
    • Dental Bridges
    • Composite Resin Fillings
    • Removable Partial Dentures
    • Removable Complete Dentures
  • Implant Dentistry
    • Implant Bridges
    • Implant Dentures
  • Restorative Dentistry
    • Tooth Colored Fillings
    • Dental Implants
    • Dentures
    • Full Mouth Reconstruction
    • Over Dentures
    • Implant Crowns
  • Preventive Dentistry
    • Oral Cancer Screenings
    • Oral Hygiene
    • Salivary Testing
    • Perioprotect Oxygen Therapy
      • Silver Diamine Fluoride
    • Home Care
      • Fluoride Trays
      • Oral Probiotics
      • Perioprotect Oxygen Therapy
    • Our Hygiene Program
      • Healthy Mouth Cleanings
      • Deep Cleanings (SRP)
      • Periodontal Maintenance Cleanings
  • Facial Aesthetics
    • Botox
    • Juvéderm
    • Facial Rejuvenation
  • Specialties
    • Endodontics (Root Canal Specialty)
      • Root Canal
      • Apicoectomy
      • Retreatment of Previous Root Canal
    • Periodontics (Gum & Bone Specialty)
      • Biological Shaping
      • Implant Surgical Placement
      • Recession Treatment
      • Bone Grafting
      • Extraction
      • Osseous Periodontal Therapy
      • Wisdom Teeth Removal
  • New Patients:
  • Existing Patients:
Welcome New Doctor to Practice