Patient Forms | Den-Care Smile Center

Patient Information Forms

Your first visit to Den-Care Smile Center establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, such as your medical history and insurance information as well as give you ample time to get to know your doctor.

At Den-Care Smile Center we value your time and your privacy. That’s why we’ve provided copies of our new patient information forms for you to download, print, and complete at home in advance of your appointment.

DOWNLOAD

New Patient Form

You may bring these forms into our office during your next visit. They will not be stored or sent online, but are offered here simply for your convenience. Den-care Smile Center follows Federal HIPAA requirements for maintaining patient privacy and healthcare portability.

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

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 Website. Also, take some time to review our staff page and familiarize yourself with the doctors – We look forward to your first visit.

“The dentists there are amazing very sweet and helpful . Took care of my issue right away.”

Esther Charmai Guerrero

“5 Stars”

S. Dewfrain

“Saw Dr.Theobald on short notice for a bad tooth. He walked me through what steps he would be taking, took care of my issue, and finished it with great directions for home care!!! I’ll be back for sure!!!”

Vanessa Rubi Perez

“Amazing work no problems at all would recommend to anyone for extractions, especially since two other dentists were not able do the work.”

Chuck Thomas

“Dr. Kozina made sure every single question I had was answered, and he is always available if I think of any more questions I want answered. Their staff is friendly and welcoming. They are also prompt and professional, and make the whole dental experience that much better. All my questions were answered and I feel a lot more confident and hopeful about my dental health. The office was very easy to locate and they have plenty of available parking. I didn’t have any trouble finding it at all. I will definitely use Dr. Kozina again. I really had a good experience, and he was by far the best Lake County dentist I have ever seen.”

Q. R.

“I didn’t have to wait at all after I arrived for my appointment. They were running right on time, which is a really big deal for me. They always take that extra step to make me feel special. I always enjoy my appointments at Den-Care Smile Center. The staff was very helpful no matter how many times I called with a question or concern. They never made me feel uncomfortable for asking any questions.”

Shannon P.

“They’ve never rushed my teeth cleaning. They always go above and beyond to make sure my teeth look and feel fantastic. You can tell they want their patients to be as comfortable as possible. I was amazed at how wonderfully they treated each of their staff members. They were so appreciative and thankful. I’ve never seen any employer treat their staff better, and it made me want to come back that much more. They were one of the kindest, most caring staff I’ve ever dealt with. It didn’t matter how many times I called with a question or concern, they were always happy to help me.”

Taba

“Don’t be misled by any negative comments people write, they simply are not true. My experience in this office was very pleasant. The doctor doing my wisdom teeth had some difficulties extracting my wisdom teeth but thank god he was able to get Dr. Kozina to help him on a Saturday morning. He got it out in less than 5 minutes. These doctors are very professional who care about their patients. Excellent staff and excellent dental assistant helping with the extraction.”

Jesus P.

“I am new to the area and was looking for a dentist who does braces for my daughter. I made an appointment with this office because it was close to my house.. When I got there the Doctors and staff were very friendly. After talking to the doctor I realized that braces were something I could afford due to the payment plans offered. I also love that I can have all our dental needs met at this one office. Thank you everyone at the Smile Center we really felt comfortable at your office.”

HBR Grl

“I had an all-around very pleasant experience. The staff was helpful and very friendly. I learned so much during my visit. They did complete x-rays and a very comprehensive exam. I now realize that i will ONLY see a hygienist for my dental cleanings. For many years i had cleanings by the dentist and the hygienist met my dental needs more thoroughly. I would recommend giving this office a try.”

August Rush