SOUTHWEST IOWA DENTAL ASSOCIATES
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New Patient Forms

Please print and complete the following forms before your appointment. 

Patient Information (PDF)  / (RTF)
Health History (PDF) /  (RTF)
HIPAA Form


Please bring your insurance card and medications list to your appointment.
COVID-19 Policies
  • All patients will be screened via phone prior to appointment and upon arrival for any COVID-19 symptoms, exposure and risk. You may be required to reschedule.
  • All patients must wear a mask upon entering the building.
  • All patients will have their temperature taken prior to entering our clinic rooms and must rinse with hydrogen peroxide upon seating.
  • Only patients receiving treatment and/or one guardian with a minor will be allowed in the building at the time of your appointment. We also ask at this time that only patients come back into the clinic area.

    How are we helping to Stop the Spread?

    ​We still offer a virtual exam option. Please call the front desk to set up.

    In an effort to help with social distancing, we are staggering our appointments and limiting dentist-patient interaction, so please be patient if you have to wait. 

    We have always followed CDC & ADA guidelines and strive to give our patients the highest quality of care possible and we truly appreciate your patience during this time!
Links for Learning
​American Dental Association- Patient Education 

Delta Dental Dentist-By-1 - Patient Education

​Dental Apps for Kids 

Dental Games for Kids 
​​
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  • Home
  • OUR SERVICES
    • Cosmetic Dentistry >
      • VENEERS
      • TEETH WHITENING
      • REVEAL CLEAR ALIGNERS
    • Family Dentistry >
      • KIDS' DENTISTRY
      • PREVENTIVE DENTISTRY
      • PERIODONTAL CARE
      • ROOT CANALS
    • Prosthetic Dentistry >
      • IMPLANTS
      • IMPLANT RETAINED DENTURES
    • Surgical Dentistry >
      • WISDOM TEETH REMOVAL
      • EXTRACTIONS
    • 3D Imaging
    • Sleep apnea devices
    • Emergency Dental Care
  • MEET OUR DENTISTS
  • MEET OUR TEAM
  • Patient Info
  • Contact Us