Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Welcome/Patient Medical History Form

These forms are mandatory for new patients. To expedite your visit, print these forms, fill them out and bring them with you for your first visit.

New Patient Forms
Welcome Form.pdf
Adobe Acrobat document [279.0 KB]
New Patient Forms
Health History.pdf
Adobe Acrobat document [123.0 KB]


Please read over and sign our Notice of Privacy Practices, No Show Policy, and Financial Responibility Policy, acknowledging each of the below policies. These forms should also be brought to your first appointment.

Privacy Notice
Privacy Practices.pdf
Adobe Acrobat document [330.4 KB]
No Show Policy
No Show Policy.pdf
Adobe Acrobat document [186.2 KB]
Financial Responibility Policy
Financial policy.pdf
Adobe Acrobat document [117.1 KB]

New Patient Paperwork


(757) 903-4525



(757) 903-2730





Pediatric Dental Specialists of Williamsburg, PLLC

213 Bulifants Blvd

Suite B

Williamsburg, VA 23188


Feel free to use our contact form to request an appointment, a receptionist will contact you by the next day of business.



Monday to Friday 8:00am-5:00pm



Outside our regular business hours, please note our emergency care information.

If a life threatening emergency, please call 911 or go to your local emergency room.  If dental related, please call the doctor on call.

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© Pediatric Dental Specialists of Williamsburg, PLLC