133 Northcreek Boulevard, Goodlettsville TN 37072 info@rivergatedentalcare.com 615.859.7117

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Make An Appointment

Whether you’re a new patient wishing to schedule your first appointment or an existing patient who would simply like to get a cleaning, fill out this form and we’ll contact you as soon as possible to schedule a convenient time for you to come in!

New patients get a free exam and x-rays!

Name:

Street Address:

City/State/Zip:

Work Phone:             Home Phone:
  

Call me at:
  Best time

Where did you hear of us?

Your Email:

NEW PATIENT FORMS…

For your convenience, we have added all the forms you will need if you are a first time patient. Please print out all 5 of these documents, fill them out and bring them with you!

New Patient Registration Form
New Patient Health History Form
Free exam and x-rays
Office Policy
HIPPA – front
HIPPA – back

You will need Adobe Acrobat Reader to view and print this form.  If you do not have Adobe Acrobat Reader click on the logo below to download the free software to your computer.

Acrobat Reader