New Patient Forms

A dental assistant helping new patient understand her tooth problem while showing it on X-ray at Mid Valley Dental

The following forms are provided to our patients online for download. Please print and complete the forms and bring them to your appointment.

If you have questions about any of the paperwork, please give us a call at (920) 215-4160 and our staff will be happy to help you.

•	Adult Patient Registration Form
•	Teen Patient Registration Form
•	Child Patient Registration Form

If you are unable to view the above forms you will need Adobe Acrobat Reader installed. Click here to download it.

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New Patient Special
$200 OFF Professional Cleaning, Necessary X-rays, and Complete Exam.
Only $99!

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Offer Expires 7/31/2020

903 E. Airport Road
Menasha, WI 54952

(920) 215-4160

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