Dr. Thomas Walther

Chesterfield Dentist

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314-469-1950

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You are here: Home / Patient Resources / New Patient Forms

New Patient Forms

To get a head start before you come in for your appointment, please review the new patient forms below. Please complete these forms beforehand. Then you can either return them to our office (thomaswaltherdds@gmail.com) or bring them with you to your first visit with Dr. Walther.

Additionally, if you have had bitewing x-rays in the past 12 months, or a panorex or full mouth series of x-rays in the past 3 years, we ask that you request those to be sent to our office.  Your records can either be emailed (thomaswaltherdds@gmail.com) or mailed to: 42 Four Seasons Shopping Center, Suite 128, Chesterfield, MO 63017.

 

TIPS:  If you are on a desktop computer, simply complete the fillable forms, save them to your computer, and email them to thomaswaltherdds@gmail.com with your appointment date for a quick and easy first appointment.

 

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42 Four Seasons Shopping Center
Suite 128
Chesterfield, MO 63017
Phone: (314) 469-1950
Fax: (314) 205-8778
Email:thomaswaltherdds@gmail.com



Download New Patient Forms

Download New Patient Forms

TELL US ABOUT YOU Truth in Lending FPC CONFIDENTIAL INFORMATION 2015 FINANCIAL AND MISSED APPOINTMENT POLICIES (1) (2)

Distinctive Dental Solutions

42 Four Seasons Shopping Center
Suite 128
Chesterfield, MO 63017
Phone: (314) 469-1950
Fax: (314) 205-8778
Email:thomaswaltherdds@gmail.com

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