Dental Consent/Registration Form

If you would like to save some time at your initial Destination Dentistry appointment, feel free to fill out this registration/consent form prior to coming in.

The registration form provides us with your personal and insurance information to create your patient record. The consent information ensures that all our patients are well informed about the specifics of dental procedures, as well as any risks or complications involved. Be sure to discuss any questions or concerns you may have with Dr. Kinniburgh. You will be asked to sign the form at our office during your first visit.

We look forward to serving your all your dental needs for years to come!

 Click here to view form (PDF)