Patient Forms - Smile Exchange
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Patient Forms

For All Locations

Hatfield Forms (Click to Open)
Online: Hatfield New Patient Registration Form
Please complete each yellow box on each form and upon completion of all forms, click “submit.”

 

Printable Form: Hatfield New Registration Form (pdf)
If you would like to print the form, please complete and bring to your first visit.

Malvern Forms (Click to Open)
Online: Malvern New Patient Registration Form
Please complete each yellow box on each form and upon completion of all forms, click “submit.”

Printable Form: Malvern New Patient Registration (pdf)
If you would like to print the form, please complete and bring to your first visit.

Springfield Forms (Click to Open)
Online: Springfield New Patient Registration Form
Please complete each yellow box on each form and upon completion of all forms, click “submit.”

Printable Form: Springfield New Patient Registration (pdf)
If you would like to print the form, please complete and bring to your first visit.

Trooper Forms (Click to Open)
Online: Trooper New Patient Registration Form
Please complete each yellow box on each form and upon completion of all forms, click “submit.”

Printable Form: Trooper New Patient Registration (pdf)
If you would like to print the form, please complete and bring to your first visit.

Turnersville Forms (Click to Open)
Online: Turnersville New Patient Registration Form
Please complete each yellow box on each form and upon completion of all forms, click “submit.”

Printable Form: Turnersville New Patient Registration (pdf)
If you would like to print the form, please complete and bring to your first visit.

Warrington Forms (Click to Open)
Online: Warrington New Patient Registration Form
Please complete each yellow box on each form and upon completion of all forms, click “submit.”

Printable Form: Warrington New Patient Registration (pdf)
If you would like to print the form, please complete and bring to your first visit.

 Current Offers

$69 New Patient Exam, X-Rays and Cleaning

Your dental care is our top priority. For that reason, we offer a $69 new patient exam, X-rays and cleaning.

* 1 Up to 8 VITA shades with Philips Zoom WhiteSpeed. Penchas, Data on file 2011. 45 minutes excluding prep-time. Pricing discounts available for Patient Loyalty Plan members. Cannot be combined with insurance or other discounts. Call for details. **Must present any coupons, ads or discount codes at time of appointment. In absence of periodontal disease. New patients only. Accepting new Patient Loyalty Plan member applications. Cannot be combined with any other offers. Subject to insurance restrictions; cannot be applied to insurance co-payments.