CHATMAN DENTAL CARE

REQUEST AN APPOINMENT

We appreciate your confidence in us and look forward to serving you. Please complete the information below and one of our scheduling coordinators will contact you to schedule an appointment.

If you have any health emergency: Please call 9-1-1. This site is not monitored for emergency care.

Please allow enough time for your visit.

⚠️ Please do not include sensitive medical or personal information in this form. For urgent or confidential matters, please call our office.

DOWNLOAD PATIENT FORMS

Please download the attached forms, fill in all the required information, and upload it to the form below.
This process will expedite the appointment process.

1. Patient Information Form

Patient Information

2. Financial Policy Form

Download Financial Policy

3. HIPAA Compliance Patient Consent Form

HIPAA Compliance Patient Consent Form

4. Patient's Health History Form

Patient's Medical History
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Patient Full Name
Address

Appointment Preference

Preferred Date / Time
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.
Click or drag a file to this area to upload.