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Patient Forms

At Associated Periodontics we want to provide more efficient registration at our office, please download our Patient Information and Medical History forms, and complete them before your first appointment. You can download the pdf forms by clicking on the links below. Thank you and please call our office if you have any questions at all.

Registration Form

Medical Health History Form

FDL – HIPPA Form

HIPPA Form

Financial Agreement Form

We try to stay on schedule to minimize waiting at the time of your appointment. Referral of emergency patients can cause delays to the schedule, and your understanding and patience are very much appreciated.

Memberships

Contact Us

The first step towards a beautiful, healthy smile is to schedule an appointment. Please contact our office by phone or complete the appointment request form. Our scheduling coordinator will contact you to confirm your appointment.

Office Location

Fond du Lac
525 East Division Street
Fond du Lac, WI 54935

West Bend
1305 Chestnut Street
West Bend, WI. 53095

Beaver Dam
109 Warren St. Suite #3
Beaver Dam, WI 53916

Our Mission

Our mission is to increase the public’s awareness of dental health, assist them in acquiring a high level of health, and educate them on how to maintain that level of health through an experience that exceeds their expectation.

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