Fort Myers, FL dentist, Kathryn Ringland, DDS, PA Ft Myers, Florida dentistry, dental office in Lee County
New Patient Forms

 

formIf you would like to complete your registration form before you arrive, you may download it by clicking below. The new patient form is in PDF format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. Also, after reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it, and bring it in, too.


Adobe PDFAdobe ReaderNew Patient Form (Acrobat PDF form)

Adobe PDFMedical History (Acrobat PDF form)


Acknowledgement of Receipt of Notice of Privacy Practices
(web page)