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

Wayne Sevick

Hygienist was on time and very thorough. Did a remarkable job. All went well and look forward to next visit.

Doug Bilgo

Always spend a very enjoyable visit with Dr. Sarah.

Tony Fleischman

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

Catherine W

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

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.

Kari Krueger

I went in for a filling and crown and everyone at KFD involved were friendly, caring and made sure I was ok and was a great experience. Would recommend them to anyone.

Chris Kuen

Today was my appointment for a crown. Everything went well, dentist and his assistant very friendly and explained everything very well as to what they were doing. I really do like going to the dentist for any work that is being done on my teeth.