Patient Forms
Patient Dental Forms

Thank you for choosing Rockville Smiles. We are looking forward to treating you. For convenience sake and to make your appointment easier, we would like to capture information for your chart and our staff prior to you seeing our dental providers. We have two easy ways for you to give us your information.


1. Our on-line form: Click Here: New Patient Registration to access it.

The electronic form is for Pedo Patients only. NOT to be used for orthodontic appointments.


2. If you aren't interested in filling out your information on-line, we have PDF forms you can print, fill out and bring with you to your appointment:


Health History Form - English
Health History Form - Spanish
Patient Information - English
Patient Information - Spanish

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The doctor would love to meet you and your family and provide you with the dental care you deserve!
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We are proud to offer the latest pediatric dental care advancements and techniques.
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