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

Photographic Authorization & Release

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

Michael Elert

Great experience, friendly staff and great location.

Mike Frederick

Great atmosphere and friendly staff. Very professional.

Andy Pipping

Entire experience was seamless. Also, the dentists, assistants and entire staff is professional and friendly. Top notch.

maria thompson

Dr. Klasinski and staff are friendly, knowledgeable, and ensure all your needs are meet! The environment is calm and beautiful! You feel like you are at home! Excellent customer service!

Cindy Horning

The Staff is so professional and Caring!

Tony Fleischman

Kewaskum Family Dentistry has been my provider for years. The team is professional, personable, and caring. And the new facilities are fantastic!

Angie Krejcarek

Highly recommend! It’s been a long time since I’ve went to a dentist and I’m really glad that I chose Kewaskum Family Dentistry. Kerry, my hygienist, and Dr. Sara are awesome. They are gentle and they explain things well. So happy my family and I are going here.

Donna Hoss

The Dentist and staff are wonderful. Kind, knowledgeable, understanding. Glad I found them.

Jack nash

A pleasant experience as always. Never a worry about being late. Always excellent care.

Susan Gorski

I was there for only a cleaning, but everyone there is always friendly. And the offices are amazing, clean and inviting.