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Patient Forms

Patient Registration Form

(PDF)

Health History Form

(PDF)

Smile Interview Form

(PDF)

Smile Interview Form

You also can complete the Smile Interview for new patients online, right here!

Name*
First Last
Phone*
Email*
Address
Street Address Address Line 2 City State ZIP Code
Are you interested in claiming one or more of our specials?
- $29 exam and X-rays for first-timers
- Implant package starting at $1999 (a sweet discount!)
- Invisalign starting at $3500 (a $1500 discount!)
Why are you visiting the dentist? Are you experiencing any pain or do you have specific concerns?
If you could, how would you change your front teeth?
- Make them whiter
- Change their shape
- Make them straighter
- Improve their overall appearance
- Is there anything else you'd like to change about them?
Can you elaborate on the other ways you'd like to change your front teeth?
If you could, how would you change your back teeth?
- Reduce the sensitivity to hold or cold
- Reduce difficulty in chewing
- Fix missing teeth
- Stop food from getting trapped
- Is there anything else you'd like to change about them?
What else would you like to change about your back teeth?
A few questions about your gums?
- Do you gums ever bleed?
- Do you ever experience gum sensitivity?
- Are you concerned about bad breath?
- Does your jaw hurt of pop?
- Do you have frequent headaches?
- Do you grind your teeth?
- Do you have removable pieces in your mouth?
Are your removable pieces comfortable?
- Yes
- No
Do you have dental anxiety?
- None
- Mild
- Moderate
- Severe
Are you interested in dental sedation?
- No
- Yes
What else? How can we help you?

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Email Address

Business Hours

Appointments before and after business hours are available.
- Monday 8am to 5pm (closed 1 hour at noon)
- Tuesday to Friday: 7am to 2pm

(417) 708-9098

FREE EXAMS & X-RAYS

Join the Dental Discount Plan for just $20/month and get two free exams per year, plus X-rays.

Dental anxiety?

A lot of people have fears about going to the dentist. We are one of the few dental offices in the Nixa area offering sedation dentistry.

SEDATION DENTISTRY

OUR DENTAL GUARANTEE!

You deserve a a dental guarantee, so we created one just for you.

ABOUT US

A husband-and-wife dental team serving the needs of Nixa and Springfield. Meet Drs. Kelly and Steve Dove.

MEET THE DENTISTS

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