Patient Portal & Forms

Patient Portal Login    Make A Payment


Please take a minute to fill out the online form. If you would rather print the forms, just print them 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.


** 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 info@vipfamilydentistry.com 

Printable Forms

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)

Now Scheduling Online Appointments – It’s Quick and Easy!

We’re making it more convenient than ever to connect with us—online appointment booking is now available!

Whether you're setting up a consultation, requesting a service, or just looking for the best time to visit, our simple scheduling tool lets you choose what works for you—all from your phone, tablet, or computer.

✅ Fast and secure
✅ Available 24/7
✅ Instant confirmation

Just click the “Book Appointment” button on our website and select your preferred time slot. Need to reschedule? It’s just as easy.

We’re here to make things simpler. Go ahead, book online today and save time!

dental4.me/vipfamilydentistry.com


Notice of Privacy Practices HIPAA (this is for your information) 
No Show / Cancelation Policy (this is for your information)
 



 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


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.
M

Mark S.
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.
S

Sandra M.
Dr. Pat and Dr. Wenona are very professional, thorough and trustworthy Dentists. I highly recommend this Dentist practice along with the Staff.
P

Patricia R.
The Vanderhei’s and entire staff are fantastic. They take the worry out of dental visits and make the experience positive. Highly recommend.
t

t6196
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.
R

Ron M.
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.
A

Angie D.
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.
P

Paul B.
Thank you for taking care of my mom's smile. We appreciate your hard work and generosity!!
A

A Luba
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.
S

S Beckman
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
C

C McLoehlan

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
Ready for your first appointment?