New Patient Forms

Once you have called to schedule an appointment, we ask that the following forms be filled out and submitted to our office. If you are unable to fill the forms out in advance, please remember to show up 20 minutes early for your child's first appointment to allow adequate time to fill out the forms. Feel free to give us a call if you have any questions. Thank you!

Rockford Forms

At this time we are not able to provide you with online forms for our Grand Rapids location (Rockford only). Grand Rapids online form capability COMING SOON!

 

**Valleau, VanDeven, and Massie Dentistry for Children cares about your privacy and personal information. The forms on our website meet federal Health Insurance Portability and Accountability Act (HIPAA) requirements and reasonable measures have been taken to secure your information. Please contact us if you have any questions or are uncomfortable providing this information online.