Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

These forms are mandatory for all new patients. To expedite your visit, print these forms, fill them out and bring them with you for your first visit.

Patient Medical History Form
Medical_History_Form_16.pdf
Adobe Acrobat document [62.6 KB]
Registration Form
Registration Form.pdf
Adobe Acrobat document [23.0 KB]

Make an Appointment Today!

Call us at: 540-740-8937

 

Jeffrey S Burns D.D.S

9626 S Congress St

New Market, VA 22844

Fax: 540-740-9227

info@jburnsdds.com

If you are a patient of record and have a true dental emergency outside of our regular buisness hours, please contact our emergency line at 1-540-217-4461.

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