We Welcome All New Patients To Mullenbach Dentistry of La Crosse!
Mullenbach Dentistry:New Patients and Their Families are Always Welcome
If you are new to the area, or you and your family are simply looking for professional dental healthcare above and beyond what you may currently enjoy, we would like to extend an invitation to visit us at Mullenbach Dentistry.
No matter if you are currently under another dentist's care, if you are simply searching for professional dental care, or if you require the specialized services that we offer, Mullenbach Dentistry would be pleased to count you among the patients and friends that benefit from our caring and skilled approach to dental healthcare.
Before You Schedule Your First Appointment
Health Forms and Medical Releases On Line To Save You Time
Before you schedule your first dental appointment with us, we've posted several health related forms and releases that you may want to download and complete prior to that appointment to save you time.
Forms
New Patient Registration Form
This form provides us with the information necessary to register you as a patient of Mullenbach Dentistry.
Please click here to open this form, to print this form, and download it to your computer.
Adult Medical Health History Form
This is self-explanatory. We will need your health history so that we can do our very best at providing the services you need in a safe way.
Please click here to open this form, to print this form, and download it to your computer.
Adult Dental Health History Form
We would like to know more about your dental health history.
Please click here to open this form, to print this form, and download it to your computer.
Children's Medical and Dental Health History Form
To assist us with providing the best dental healthcare for your child or children, please complete our Childrens Medical and Dental History Form (One Per Child).
Please click here to open this form, to print this form, and download it to your computer.
HIPA Authorization Forms
These forms are government mandated by the Health Insurance Portability Act, or HIPA. These forms ensure your privacy, and allows us to share your records with other medical providers and with your insurance company.
HIPA Privacy Notification Form
HIPA Consent To Share Information Form
Consent Form
This form allows us to treat you, your child, or a person for whom you are the legal guardian.
Please click here to open this form, to print this form, and download it to your computer.
If you have any questions about these forms, please contact us at (608) 782-6616 and we would be pleased to help you.
