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

Maria Metke

Friendly staff and great Doctor!

Janice Hahn

I am a newer patient to Kewaskum Family Dentistry and I must say it has been a very pleasant experience. The staff are friendly and knowledgeable. My questions are welcomed and answered to my great satisfaction. Would definitely recommend this dental practice.

Jan Guse

Prep and completion of needed crown procedure - very impressed with friendly treatment, professional services, and especially the concern of all staff involved.

Laura Meyer

The new clinic is beautiful and very welcoming. Both girls in the front smiled and welcomed us as we came in. My husband saw Denise for a cleaning. He said she was friendly and felt she did a good job.

Jeff Richter

Great service wonderful people. I love going to the dentist!!

Kim Wimmer

I’ve only had my initial cleaning visit so far. This was my first time at a dentist other than the one I grew up with for the last 30+ years. I get really anxious going to the dentist, and they did their best to walk me through everything and make me feel comfortable.

Holly Machi

By far the best place we’ve been too! They got my son in for an emergency and made him feel special and loved and not rushed. They genuinely cared about his well-being. Every single person there smiled. What a refreshing place and Gibbs…..he was the real MVP 😉Thank You!!!!

David Waszak

They were great with my 3 year old son very polite and friendly the atmosphere was excellent and they were understanding that my son was nervous about being there

Catherine W

Every one was kind , patient, and actually listened to my concerns
I was exceptionally happy with the service I received

Jeff Backhaus

Very professional and friendly