Matthew T. Kingston, DMD
Healthy Smiles Dental - Matthew T. Kingston, DMD

Healthy Smiles Dental at Woods Edge Plaza
144 S. Centerville Rd. at Columbia Ave. Lancaster, PA

717.945.7440

144 S. Centerville Rd., Lancaster PA
Call for an Appointment - 717.945.7440

 FREE Healthy Smiles Rewards Program: Get an Extra 100 Points with Your First Service!

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Patient Forms

Healthy Smiles Dental invites patients to download and complete these patient forms prior to their visit

 

When you visit Healthy Smiles Dental, you will be asked to complete our patient forms. Please allow enough time to complete these before your appointment. As an added convenience, feel free download and complete these forms prior to your visit and bring them with you. Thank you for choosing Healthy Smiles Dental. We look forward to serving you!

 

Healthy Smiles Dental Patient Information and Health History Form .PDF
You can fill out this form and email it, then sign it when you come to the office, or you can print it out, sign the filled-in form and bring it with you. (This packet also includes the Healthy Smiles Dental privacy notice and a form to request transfer of patient records to Healthy Smiles Dental)

Healthy Smiles Dental Smile Rewards Program Patient Enrollment Form .PDF

Healthy Smiles Dental Financial Policy .PDF