New Patient Form Download

We want to deliver the same quality care in these unique circumstances while helping prevent the spread of COVID-19. Would you please help us to streamline your appointment by completing your patient forms online in advance? We have provided a convenient way to complete your new patient forms before arriving for your appointment.

dental treatment form for new patient

Click on the PDF icon below to download the PDF form, complete the form by filling it out, print it, and bring them to your appointment. If you have any questions, please don't hesitate to call us at (281)531.0710.

As a courtesy, we will process your out-of-network insurance benefits in our office, in our continued commitment to provide a combination of the highest-quality and most affordable dental care.

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About

Dr. Shimizu is an accredited member of the American Academy of Cosmetic Dentistry. There are 419 dental professionals worldwide (Only four in Houston) as of 2022 who have achieved this prestigious honor.