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

Keith Roever

Very friendly. Would recommend anyone

Katherine Ruck

I have to say that this was the best experience I’ve ever had with a cleaning of my teeth!! Everyone is so friendly and helpful!! I’ve found my forever Dentist and Dental Technician at Kewaskum Family Dentistry ❤️

Bruce Weninger

👍Had an issue with a crown and Sara helped me out even though they are in the process of setting up their new office.

Bob Proudfoot

I always enjoy going to Kewaskum Family Dentistry. I’ve been going there so long that the staff feels like family. Everyone is professional and friendly, and truly care about their patients.

Donna Hoss

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

Jennifer Koepke

Dr. Garrett and Sarah are the best. They talk to me and make my visits enjoyable. I hope they will take care of me forever!

Laura Meyer

My husband Jim had some deep cleaning done. It was his second visit to Kewaskum Family Dentistry. The hygienist was friendly and professional. Jim felt she did a great job and was very efficient. It did not hurt afterwards and he felt his teeth were very clean, it was an excellent job. Thank you!

P Stokkers

Great people and great service

Jon Herdrich

My new crown feels great! Easy and painless!

Jean Mahoney

I never thought a trip to the dentist would elicit warm and fuzzy feelings, but every single person was pleasant and professional. So happy they're my team!