We understand that your time is important and we want to make your visit as enjoyable and convenient as possible. For your convenience, we have provided a patient form that you can download, print, fill out and bring with you to our office.
To complete the form, right-click on the box below and download a copy to your Desktop.
Complete the form using Adobe Acrobat Reader and Save.
Patients of the Irving office, email the completed form to marketplacedental@gmail.com or print and bring with you to your first office visit.
Patients of the Grand Prairie office, email the completed form to activedentalgp@gmail.com or print and bring with you to your first office visit.
Click on the link below to download the PDF form:
**If you do not have Adobe PDF Reader, download it here.