Contact Us: 928-344-5700

Monthly Special

New Patient Special
$59 Cleaning with Free Exam & X-rays

Contact Us to Get Started!


Offer valid in absence of Periodontal Disease. Cannot be combined with other offers. Limited time offer.

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Patient Forms

We get it — filling out forms is not your favorite way to spend time. At Yuma Dental, we’ve made this necessary paperwork as convenient as possible. We’ve put our forms online for instant access. You can fill out these new patient forms and read about our financial policy at a time that works for you — from the comfort of your own couch.

While filling out all this information may feel tedious, it’s important for us to have all the details we need about a patient before we begin treatment. This helps us get to know the person we’re treating and clues us in to any questions we should be asking about your medical history, ensuring you get the best possible care at our Yuma, AZ, dental office.

   

Patient Information Form

Please fill out this form if you'd like to become a new patient, or if you are a current patient and need to update your information.

You’ll need to provide information about your most recent dental visits, previous dentist's name and address, medical history, dental history, including orthodontic work, and dental insurance. This form will only take a few minutes to fill out.

Financial Policy

This document outlines our financial policy, explaining when payment should be submitted, how you will be billed and our policy on broken appointments. Contact us with any questions.

Download the patient forms before your first visit. You can either email them back to Yuma Dental or bring them to us at your next visit. This also saves you the hassle of having to fill out these forms upon arrival for your appointment — when you already have a million things running through your mind during your busy day.