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Please take a minute to fill out the online form. If you would rather print the forms, just print out the forms and bring them with you to your dental appointment. You may also access our online patient registration by clicking the link below.
Adult Online Patient Registration Form
Child Online Patient Registration Form
** Please note that x-rays will be taken on FIRST appointment unless you bring current x-rays with you or have them emailed to our office. They can be emailed to firstname.lastname@example.org OR email@example.com
New Patient Health form ( NEW PATIENTS)
FINANCIAL & HIPAA (NEW PATIENTS)
EPWORTH SLEEPINESS (NEW PATIENTS)
INTERNET CONSENT (NEW PATIENTS)
COVID ( ALL PATIENTS, EVERY VISIT)
Medical update (ESTABLISHED PATIENTS ONLY)
Patient Referral (REFERRING DOCTORS)
Notice of Privacy Practices HIPAA (this is for your information) No Show / Cancelation Policy (this is for your information)
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Outstanding services. I just cant say enough about this dental office, they go above and beyond to make your visit comfortable, pleasant,and professional. The entire staff is great.
Dr. Wenona was able to save a tooth that had a below gumline issue. She referred me to a periodontist then finished the final procedure herself. Prices are reasonable (I'm self-pay) and the staff is positive all the time.
Dr. Pat and Dr. Wenona are very professional, thorough and trustworthy Dentists. I highly recommend this Dentist practice along with the Staff.
The Vanderhei’s and entire staff are fantastic. They take the worry out of dental visits and make the experience positive. Highly recommend.
VIP Family Dentistry is absolutely first rate! Best group I have ever had. Dr. Patrick is highly skilled and always puts me at ease . Jennifer has made my cleaning sessions easy . Beth and Heather and Brittany always greet me with a smile. Highly recommended.
The VIP team is simply amazing. They don't just care about your teeth, they care about YOU. In today's world, that kind of care is almost impossible to find anywhere. I adore this staff, and Dr.s Van Derhei.
All I can say is if these folks are amazing. The office staff is very friendly and accommodating. Dr. Pat has gone above and beyond in treating me on several occasions.
Thank you for taking care of my mom's smile. We appreciate your hard work and generosity!!
Sometimes its really difficult to express in words or on paper your appreciation. Dr Wenona, you and your staff met and exceeded all my expectations. You made my biggest fear become an easy, comfortable experience. I felt as though I was the priority, not the next customer waiting. You all took your time, explained each of my options and answered all my questions, not once did I feel rushed or pressured to make a decision. Thank you all so much for your patience and for the care you showed me through what could have been a very terrifying experience.
Dr. Wenona, Just wanted to let you know how much Megan and I appreciated you seeing her in your office on Father's Day. Thank you