New Patient Forms

Please click on a link below to download the form. Take a moment to complete the form and bring it with you to your first appointment. We look forward to serving you.

Stay Connected!


In an effort to contain and prevent the spread of Covid-19, we adhere to Federal and State regulations, by the ADA, OSHA and by the Ohio State Dental Board. We continue to follow strict guidelines for the way in which we disinfect, what products we use, and how to keep all patient contact fully isolated from staff and other patients. 

Dr Jackson and his staff were pleasant, professional and made me feel at ease, since this was my first visit to a dentist after COVID hit. Dr. Jackson explained everything he was doing, both because of the pandemic and everything around my x-rays and examination. He has a gentle touch, which was good for me and my 73 year old mouth!! Every thing about my appointment was top notch! Many thanks to all…

Fran G.