New Patients

Welcome to Atlantic Coast Dentistry!

Thank you for choosing Atlantic Coast Dentistry of Deerfield Beach for your dental care needs. We look forward to meeting you and helping you achieve optimal dental health. If you have any questions or concerns, please do not hesitate to contact us.

Please arrive 15 minutes early for your appointment to fill out the necessary paperwork for new patient intake. Or, if you prefer, you can download, print and fill out the forms below and bring them with you to speed up your intake process.

New Patient Intake Forms

Click on button(s) then choose to print or download

Release of Records Form

We are excited to have you as a new patient and are committed to providing you with the best possible dental care. To help us provide you with the most comprehensive care, we ask that you provide us with the following information prior to your appointment:

  1. Contact Information: Please provide us with your full name, address, phone number, and email address.
  2. Dental Insurance Information: Please provide us with your dental insurance information, including the name of your insurance company, your policy number, and your group number.
  3. Medical History: Please let us know about any medical conditions you may have, such as diabetes, high blood pressure, or heart disease. Please also let us know about any medications you are taking, as well as any allergies or other medical concerns.
  4. Dental History: Please let us know about any previous dental treatments you have had, including fillings, crowns, bridges, or implants. Please also let us know if you have any current dental concerns, such as tooth sensitivity, pain, or bleeding gums.
  5. Payment Information: We accept a variety of payment options, including cash, checks, and credit cards. If you have any questions about payment options or financing, please let us know.
  6. Appointment Preferences: Please let us know your preferred appointment time and date, as well as any special needs or accommodations you may require.
  7. Any appointment that is cancelled with less than 24 hour notice will result in a $45.00 fee being charged to patient’s account.

Call us at (954) 360-2989
or

Request Appointment