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

Carl Steiner

Excellent experience, first time there!

Patrick Hayes

Super nice people, very informative, great office and very knowledgeable.Best dentist I have been to.

Joan Lickman

Friendly and knowledgeable. No waiting time and thorough.

kay mueller

Got an appointment right away- they fixed my tooth right up and I was in and out in 20min

Maria Metke

Friendly staff!!

Markus Helman

Very polite and do a fantastic job!

Todd Flitter

friendly atmosphere , smiling faces, great dog and always have the patients 1st

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.