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New Patient Forms

Hand filling out form

The following forms are provided to our patients online for download. Please print and complete the forms and bring them to your appointment.

If you have questions about any of the paperwork, please give us a call at 256-460-4191 and our staff will be happy to help you.

New Patient Forms
Healthy Smile Protection Plan

Multiple Locations to Serve You

Tuscumbia

121 East 6th Street, Tuscumbia, AL 35674
Phone: 256-712-2240

Florence

2604 Hough Road, Florence, AL 35630
Phone: 256-712-3549

Muscle Shoals

2402 Avalon Ave Suite A, Muscle Shoals, AL 35661
Phone: 256-712-3186

Russellville

531 St. Clair Street SE, Russellville, AL 35653
Phone: 256-460-4191

SRD on 5th (Pediatric)

115 East 5th Street, Tuscumbia, AL 35674
Phone: 256-712-4080

Phone

Hours

Monday: 8AM - 4:30PM
Tuesday: 8AM - 4:30PM
Wednesday: 8AM - 2PM
Thursday: 8AM - 4:30PM
Friday: Closed

New Patient Forms

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