New Patients

Welcome to the Paulson Dental family

"I can’t say enough good things about Dr. Paulson and her team. They’re professional, kind, and truly care about their patients." - Troy “Love this group! Such a great fun group and excellent service for my needy teeth! Recommend them highly!” - Linda “With Dr. Paulson and her team, I finally feel comfortable going to the dentist!” - Darla “The entire staff is amazing! I would highly recommend Paulson Dental to anyone.” - Lynn “It’s being treated as a friend and not just a patient! Everyone working there is great! Paulson Dental Feels like family!” - Diane

Family Focused

At Paulson Dental, we want to make sure you feel comfortable from the moment you call us to the moment you leave our office. We are a small, family-focused team, which means we take the time to get to know you, your history, and your specific needs.

To help your first appointment run as smoothly as possible, we have provided our new patient forms below.

New Patient Form

New Patient Form Child

What to Expect

We know that considering a new dentist can sometimes feel overwhelming. That is why we focus on keeping things simple and stress-free. When you arrive at our office on 33rd and Western, you will be greeted by a friendly face, not a corporate kiosk.
During your first visit, Dr. Jill Paulson will perform a comprehensive dental exam. We will check the health of your teeth and gums, take any necessary X-rays, and discuss any concerns you might have. If you are here for a teeth cleaning, our gentle hygienists will make sure your smile is polished and fresh.

Patient Forms

We value your time. To expedite your process, you can complete your paperwork before you even arrive. You have the option to fill them out securely online or download them to print at home.

Please choose the option that works best for you:

New Patient Form – Online

Personal Information

Name(Required)

First Last

Date of Birth(Required)

Gender(Required)

Marital Status

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Home Number(Required)

Cell Number

Work Number

Employer

Employer Address

Street Address Address Line 2 City State ZIP Code

How long there?

Occupation

Who may we thank for referring you?

Other family members seen by us?

Previous/Present Dentist

Last vist date

Primary Insurance Information

Dental Coverage?(Required)

Yes

No

Insurance Company Name

Insurance Company Address

Insurance Company Phone

Insured's Name

Relation

Insured's Birthday

Employer Address

Insured's Employer

Secondary Insurance Information

Dental Coverage?(Required)

Yes

No

Insurance Company Name

Insurance Company Address

Insurance Company Phone

Insured's Name

Relation

Insured's Birthday

Insured's Employer

Employer Address

New Patient Form – Download

New Patient Form Child – Online

Initial Exam

Child's Name(Required)

First Last

Nickname (if any)

Date of Birth(Required)

Child's Address(Required)

Street Address Address Line 2 City State ZIP Code

Hobbies, Sports and Interests

Person Responsible for this Account:(Required)

First Last

Relationship to Child(Required)

Residence Address(Required)

Street Address Address Line 2 City State ZIP Code

Residence Phone(Required)

Email(Required)

Employed By

Business Phone

Business Address

Street Address Address Line 2 City State ZIP Code

Insurance

Please give insurance card to front desk

How did you hear about us?(Required)

Dental Insurance Plan (If any)

Date of Birth

New Patient Form Child – Download

Insurance & Payment

Simple & Transparent Billing

We believe in being upfront about care and costs. We accept most major dental insurance plans and will happily file the claims for you. If you have questions about your coverage or payment options, just give us a call. We are happy to help you figure it out so there are no surprises.

Learn About Us