3560 Delaware Street,Ste 102, Beaumont, TX 77706, 409-892-2600

 

 

 

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Patient Forms, Map and Directions to Beaumont Office

Your first visit to Beaumont Smile Center involves a few steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can also save some time by printing out and completing the patient forms in advance of your appointment.

Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

  • Listening to those we are privileged to serve.
  • Earn the trust and respect of patients, profession and community.
  • Exceed your expectations.
  • Ensure a creative, challenging and compassionate professional environment.
  • Strive for continuous improvement at all levels.

Patient Forms
Please print and fill out these forms so we can expedite your first visit. If you are a patient of record, please print only first two files to update Patient Information and Medical History.  

  1. New Patient Form
  2. Medical History
  3. Financial Policy
  4. HIPPA
  5. Financial Policy
  6. Patient Record of Disclosure
  7. Informed Consent for Nitrous Oxide-Oxygen
  8. Handle Me With Care Form.PDF
  9. Questionnaire for Children.PDF
  10. HIPPA Notice of Privacy
     

 In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.


What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors and office staff. We look forward to your first visit.


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