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NEW PATIENT SPECIALS

Offer #1: $49 Emergency Exam
Offer #2: $99 Exam, Xray, & Basic Cleaning
*For uninsured patients only | offers can’t be combined 

Dedicated Dental

Patient Forms

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Post-Op Instructions

Henderson (702) 566-5509

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  • Meet Our Staff
  • Services
    • Family Dentistry
      • Pediatric Dentistry
      • Adult Dentistry
    • Cosmetic Dentistry
      • Lumineers
      • Clear Liners
    • Post-Op Instructions
  • Emergency Dental Care
  • Dental Technology
    • CEREC 1-Day Crowns
  • Specials
  • Contact Us
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Request an Appointment

Please do not use this form if you have an urgent medical problem or need to reschedule an existing appointment. Instead, contact our office at (702) 566-5509.

After you submit your request, our appointment scheduler will respond within 48 hours. Please allow extra time if you submit this request on a weekend, we will respond to you on the next business day. Thank you and we are looking forward to seeing you soon at our office.

See below for forms to complete.

Dentist  seeing patient's dental problem

Patient Registration Forms

Dedicated Dental in Henderson, Nevada, welcomes you to our practice. Once you have made your initial appointment, you may pre-register by downloading, printing, and completing the forms below. Doing so prior to your visit will help speed up the new patient registration process.

Please be sure to bring all forms with you to your first visit, along with any diagnostic films or other test results that may have been ordered or performed by another physician.

 Downloadable Forms:

NEW PATIENT FORMS:

  • Patient Information Form
  • Medical History Form
  • Financial Agreement Form
  • HIPAA Form

RETURNING PATIENT FORMS:

  • Patient Information Form
  • Medical Update Form

Please note:  It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

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Contact Us

We welcome your questions about our general, cosmetic, or restorative dental services! We’re conveniently located in Henderson, a suburb of Las Vegas, Nevada. You can also take a 360-degree tour of our offices before you visit us!

Learn More

Contact Us

We welcome your questions about our general, cosmetic, or restorative dental services! We’re conveniently located in Henderson, a suburb of Las Vegas, Nevada. You can also take a 360-degree tour of our offices before you visit us!

Learn More

Patient
Education

Would you like to learn more about common dental conditions and their treatment? Visit our interactive patient education library.

Learn More

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  • Smile Gallery
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  • Cosmetic Dentistry
  • Dental Technology
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  • Emergency Dental Care
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Request an Appointment

70 E. Horizon Ridge Pkwy.
Suite 150
Henderson, NV 89002
Phone: (702) 566-5509
Fax: (702) 566-5198

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Dedicated dental offers dental services - Family Dentistry, Cosmetic Dentistry, Pediatric Dentistry , Adult Dentistry , Clear liners , Porcelain veneer & Emergency Dental Care In Henderson, Nevada.