1000 W Nifong Blvd, Building 6, Suite 130 | Columbia, MO 65203
Columbia Phone: 573-874-1990
info@columbiadentistryforchildren.com

931 Wildwood Dr, Suite 104 | Jefferson City, MO 65109
Jefferson City Phone: 573-634-1990
jeffcitykidsdds@gmail.com

Patient Forms

NEW PATIENT PAPERWORK
To schedule your child's first appointment complete our Secure Online Health History Form. It submits electronically to our office so you do not need a printer. This form allows us to schedule efficiently as well as provide the highest quality care to your family. Our New Patient Coordinator will reach you using the contact information you provide on the form! 

RECORDS RELEASE
Has your child seen another dentist before coming to our practice? We will need their most recent        X-Rays and the date of their last appointment. Some offices require a signed records release form. 

 NON-PARENT CONSENT
We encourage all parents or legal guardians to accompany their child to each appointment.  If the parent is unable to accompany their child to the appointment, please complete the form below.

PRIVACY POLICY
Please click on the links below to view our privacy policy.

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