New Patient Forms

New Patient Forms 2018-08-03T03:55:22+00:00

Online Download

At Cottonwood Smiles, we offer patient forms online so you can complete them in the convenience of your own home or office. Fax us your printed and completed forms or you may bring them during your visit.

If you do not have AdobeReader® installed on your computer, Click Here to download.

New Patient Registration Form
Welcome!

Download & Print Form

Appointments

We will do our best to accommodate your busy schedule. Schedule an appointment today!

Please complete the following form to request an appointment. Please also note that availability will vary depending on your request. Your appointment will be confirmed by phone by a member of our staff. Thank you!

Phone: (928) 202-3376

637 North Main Street, Suite 1-C
Cottonwood, AZ 86326