21343 Archibald Road, Deerwood, MN 56444
218-534-3141 / 800-477-7645
With extended hours
we are always here to help
you get the care and the smile you need.

Form Center

Below you will find all of the frequently used Patient Forms for our practice. You can take a look at any form and you may be asked to download and fill out a form when scheduling an appointment at any of Northland Smiles offices. These forms all require the use or Adobe Acrobat Reader which can be downloaded by clicking the image at the bottom of the page.

New Patient Forms

To save you some time, please fill this form out before arriving on your first visit
Medical History Form  
HIPAA Form  
Signature Form  
   

Consent Forms

 
Consent for Minor Child A consent form for treatment of your minor child
Consent for Special Needs A consent form for treatment special health care needs
   

Prepay Plan

 
Prepay Plan Information Information on our prepay dental plan (an alternative to dental insurance)
Prepay Plan Signup Form Sign up form for our prepay dental plan (bring this filled form to us to join!)
   
Forms on this page require Adobe Acrobat Reader.
To download Adobe Acrobat Reader, click the image below.