Midwest Dental


ALMOST DONE. One more step.

Thank you for completing the Pre-Appointment Questionnaire. You need to print your results now. If you are unable to print, it’s okay – you can complete a paper version of the form when you arrive to our office.

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Pre-appointment screening form

Please download and print the form.

NOTE: We now charge a small fee to cover a portion of the increased cost for personal protection equipment (PPE) and infection control. Many insurance providers now cover this fee.