Patient Forms

Thank you for choosing Kewaskum Family Dentistry! Below you will find links to our online forms, or if you prefer, you can download them to print and fill out before you come in for your appointment.

Patient Forms

Thank you for choosing Kewaskum Family Dentistry! Below you will find links to our online forms, or if you prefer, you can download them to print and fill out before you come in for your appointment.

Patient Forms

Thank you for choosing Kewaskum Family Dentistry! Below you will find links to our online forms, or if you prefer, you can download them to print and fill out before you come in for your appointment.

New Patient Forms

Online Forms

New Patient Letter

Patient Info

Health History

TMJ Health Questionnaire

Myosleep Kids Questionnaire

COVID-19 Prescreening

PDF Forms

Receipt of Privacy Practices

Why Our Membership Plan Might Be Right For You

No dental insurance? Children and adults can still receive the same great dental care with our membership plan.

Yearly membership plan to cover routine cleanings and exams and even emergency visits
Save money and receive the dental care you deserve
Payment options available

Why Our Membership Plan Might Be Right For You

No dental insurance? Children and adults can still receive the same great dental care with our membership plan.

Yearly membership plan to cover routine cleanings and exams and even emergency visits
Save money and receive the dental care you deserve
Payment options available

Why Our Membership Plan Might Be Right For You

No dental insurance? Children and adults can still receive the same great dental care with our membership plan.

Yearly membership plan to cover routine cleanings and exams and even emergency visits
Save money and receive the dental care you deserve
Payment options available

I simply cannot say enough great things about Kewaskum Family Dental. The ladies up front were all so nice, welcoming, and knowledgeable. Everything was super smooth and easy. Dr Sara is simply the BEST dentist I have ever gone to! She is so gentle and warm and she explained each step to me in words I could understand. Her assistant Molly was great too. She brought me into the room and just chatted away with me to put me at ease. Anyway, GO, you will be so happy you did!

Kendall Butler

1715210286

Thanks for your great professional service. Excellent staff. Always professional, helpful, and knowledgeable. No pain! Thank you all.

Cheryl Touchett

1715209385

Excellent experience 5 stars

John Bischoff

1714605858

Very kind and patient care. Dr. Sara is the absolute best. No rushing the procedure that I was hesitant and a bit scared to have done.

Pam R

1714460377

Gentle and compassionate dentists.

Jackie Fechter

1714172503

Professional and friendly

Linda Stengel

1713828267

Always greeted with smiles, I have never been disappointed at any visit. Today,I was worried for the worst, was so happy to hear and all good to go.Thanks,Dr.Sara and staff.

Ceal Waala

1713715375

Amazing staff, clean building. Highlight for me is the sweet dog that wanders around.

Jesse Winkler

1713396739

They use state of the art equipment for measuring/diagnosing various dental-related issues. The staff is very friendly. They send lots of reminders about upcoming appointments.

Jody Geenen

1713162470

The entire staff has always been great and so wonderful towards me and my 3 children. Everyone has been unbelievably kind to myself and my children when we found ourselves going through some challenging time at home. They were patient and understanding which meant everything to me at the time. I couldn’t of asked for a better dentist and dental team to respond to my situation with

Amber Leszczynski

1712895069