Patient Registration

New Patients:

     Please complete your Patient Registration

          prior to your initial office visit.


          New Patient Registration Form

Established Patients:

     Please complete the following forms,
         upon request, prior to your office visit.

     Release of Records Form

         HIPAA Consent Form

         Financial Consent Form

         Medical History Form 

For more information about Marigold Family Dentistry or to schedule a consultation with Dr. Hoekstra, call our office in Holland, MI at Marigold Family Dentistry Phone Number 616-288-4777.