New Patient
Forms

New Patient Forms and Registration at Dedicated Smiles

Below are the new patients forms we require at Dedicated Smiles. You may print a copy to bring to your visit, or you may submit them electronically here. Either way you prefer, we want to make your registration with our office as simple and convenient as possible. If you have questions or would like to arrange a visit with our dentist, please give us a call. We look forward to providing you with quality dentistry in Woodbridge, Virginia.

  • New Patient Registration Form (required)
  • Office and Financial Policy Form (required)
  • Acknowledgement of Privacy Practices (required)
  • Treatment of a Minor Form (required if needed)
  • Notice of Privacy Practices (required)

forms

GOT QUESTIONS? Send Us A message

Please enable JavaScript in your browser to complete this form.

PATIENTS REVIEWS

TRUSTED BY PATIENTS IN WOODBRIDGE, VA FOR 20 YEARS

Instagram

Comprehensive Dental Services in Woodbridge, Virginia

We offer a variety of dental services in Woodbridge, Virginia, to improve the health and appearance of your smile. Contact us at 703-583-7720 with any questions or to schedule an appointment with Dr. Abu-Bakr El-Masry.

Your journey to a healthier smile starts here!