ACCESSIBILITY
Plover Family Dental Care
Dr. Roger J. Gollon
Personalized Excellence
Call: (715) 341-7665

Patient Forms

If you are a new patient to our office, the attached files contain our new patient registration forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Health History Page 1
Health History Page 2

Notice of Privacy Practices 

Addendum to Notice of Privacy Practices

Receipt of Privacy Practices

Wisconsin Dental Consent Page 1
Wisconsin Dental Consent Page 2

 

 

 

 

 

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.