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

Andy Hanke

This place is very professional and always make you comfortable and relaxed.

Tony Fleischman

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

Gary Malcolm

My wife has been going to Kewaskum Family Dentistry for over 3 years and I am really glad she convinced me to give them a try. My experience there was better than I expected.

Denise Ray

I’ve always been a little scared of the dentist when I need to get a shot or anything invasive. These guys are awesome. Keep me calm and did a great job.

Gisele Morris

Easy to set appointments. Beautiful new building, state of the are equipment
Friendly staff and knowledgeable. Hygienist explained procedures to me. Dentist did not "push" for any expensive treatment, but when I asked, they were pleasant and explained options.
Great first time experience. Glad I decided to change dentists.

Marilyn Bohn Holland

The staff at Kewaskum Family Dentistry is beyond the best!! They make you feel comfortable and at ease. Never have I had a bad experience.

Corinne Kulhanek

Normally I have very high anxiety about dentists. After my first visit to Kewaskum Family Dentistry, I’m more than willing to return for my future appointments. I’ve never felt so at ease. They are very gentle, explain everything prior to what is going to be done, nonjudgmental, extremely friendly and calming. Highly recommend!!

Corinne Mary

I have horrible anxiety about going to dentists! I have never felt so relaxed and calm at a dentist than I did here. They are gentle, friendly, nonjudgmental and treat you like a good human. Best experience I’ve ever had and look forward to future appointments!

Joyce Plautz

I had the best visit yesterday. Everyone was soo nice. It had been years since I saw a dentist and would highly recommend then to everyone!!

Maria Metke

Friendly staff and the Doctor was great with my son!!