Please complete the forms below and bring it with you to your new patient appointment. This will save you time on the day of your appointment and allow us to attend to your dental needs more quickly. You may contact our office at any time with questions!
Email and Text Messaging Registration Form: Text Policy.docx
Patient Medical History Form: Medical History.docx
Patient Medical History Form (2): Medical History (2).docx
HIPAA Form: HIPAA Form.doc
Financial Policy Form: Financial Policy.docx
Cancellation/No-Show Policy Form: Cancellation Policy.docx
X-RAY Release Form: X-ray Release Form.doc
Treatment Without Guardian Consent Form (for minor patients who will be brought to future appointments by someone other than their legal guardian): Treatment without guardian consent form.docx
This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.
Dr. Ersan and her team are the best in the world in my opinion! I came to Apple Blossom with very serious tooth decay as I had been neglecting my teeth and avoiding going to the dentist and had major issues. They never judged me or tried to shame me like other dentists in the area had. They helped me to fix the problem in a very professional manner and I couldn't be happier with the results. Lilliannah, Dr. Ersan's dental assistant, was especially helpful and comforting through the whole process and they are all some of the nicest people you will meet!
Peter G. (Google)
Dr. Ersan is the best dentist I have experienced as an adult. I had work done (fillings) previously by a Dentist who cut a lot of corners and left me a bit anxious about dentistry in general. Dr. Ersan spent an hour with me, going over x-rays, explaining what had been previously done and what she planned to do to to keep my teeth healthy. She performed the cleaning herself and even prescribed toothpaste for my sensitive teeth. The rest of the staff were super pleasant and the office was incredibly clean and bright. Definitely have found my forever adult dentist.
Taylor K. (Google)
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