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New Patient Forms

New Patients may print forms to fill out prior to their appointment. Click the link below to print out our forms.

Options for Submitting New Patient Forms

  1. Fill them out ahead of time
  2. Fill them out the day of your appointment


When Filling Out Ahead of Your Appointment

For Douglasville

  • Drop them off anytime before your appointment
  • Mail Forms: West Georgia Family Dentistry, 8590 Bowden Street, Douglasville, GA 30134
  • Fax Forms to: 770 949-0707
  • Bring them to Your Appointment

For Bremen

  • Drop them off anytime before your appointment
  • Mail Forms to: West Georgia Family Dentistry, 107 Valley Run Dr, Bremen, GA 30110
  • Fax Forms to: 770-537-9659
  • Bring them to Your Appointment

Form must be received at least 72 hours prior to your appointment in order to verify your insurance benefits. Once benefits are verified, you may only be required to pay your deductible and portion of your charges at the date of service.

If your insurance has not been verified at the date of your appointment, charges are to be paid in full and we will be happy to submit your insurance to you for reimbursement.


When Filling out the Day of Your Appointment

New patients may fill out forms at our office 15 minutes prior to their dental appointment.*

*When using this option, your charges are to be paid in full at your first appointment. Any other financial arrangements must be made in advance.