3200 Old Jennings Rd.
Middleburg, FL 32068 (904) 505-2010 Pay: Middleburg
3267 Hodges Blvd. #13
Jacksonville, FL 32224 (904) 361-3370 Pay: Jacksonville
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To continue making your dental experience as pleasant as possible, we have conveniently provided our dental forms below. You can either fill them out through our secure website and submit them to the office of your choice or print the forms and bring them with you to your appointment.
New Patient: Child
Children’s Medical History
Child’s Informed Consent
HIPAA/ Generalized Patient Consent
For New Patients Who Are Still Nursing
Frenectomy
Sleep and Speech
Sleep and Speech Questionnaire
New Patient: Adult
Adult Medical History (seen at our Middleburg office)
HIPAA/ Generalized Patient Consent
Records
Transfer of Records
Treatment
Treatment Deposit
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Myers Pediatric Dentistry & Orthodontics would love to meet you and your family and provide you with the dental care you deserve! Our two offices are easily accessible to those living near Middleburg and Jacksonville to get the care they deserve.
Click here toRequest An Appointment OnlineOr call us today at:
Middleburg: (904) 505-2010
Jacksonville: (904) 361-3370