ADULT FORMS

At Parkway Plaza Dental, we want to make sure your visit as smooth and enjoyable as possible.Our Patient and Medical History forms are found below. For your convenience, please print and fill out the forms found below.

New Patient Forms:
These forms provide us witht the necessary information to best serve your needs.

To fill out your form and submit online, please visit the following page:
Parkway Plaza Dental Online Welcome & Health History Form

The following forms below can be printed and brought to Parkway Plaza Dental the day of your appointment or scanned/emailed/faxed to our office:

Welcome to Parkway Plaza Dental answers the general questions about you and your family, contanct information, dental anxiety concerns, and the reason for your visit.
Welcome to Parkway Plaza Dental.pdf

Health History gives our team of doctors and hygienists medical background information to make sure we are providing the type of dentistry that best suits your history and needs.
Health History

Allowing us to check your dental insurance benefits allows you to get the best possible treatments, both preventative and diagnostic. This will make sure there are no unexpected bills and surprising, keeping you informed.
Dental Insurance Information

Everyone has different dental needs. This form allows our team to see what your concerns are, any questions you may have, and what procedures to enhance your smile you might be want to learn more about.
Oral Health Care Survey

The following forms are there to make sure you are in full control of your dental treatments. Making sure your records and health information are protected, and fully aware of your dental benefits.
Consent For Use and Disclosure of Health Information
Financial Policy and Consent for Services at Parkway Plaza Dental

Care Credit Healthcare:
We're pleased to accept Care Credit, North America's leader in patient helathcare financing. CareCredit lets you begin your treatment right away and pay for it over time with monthly payments that can easily fit into your budget. Click below to apply or call us to learn more!
Apply now for CareCredit

If you have any questions, please give us a call at 913-345-2929. We would be happy to assist you in any way we can!



phone: 913.345.2929 Protect & Enhance All your Smile Needs at One Location!