Dental Patient Forms

We’ll need the information on the forms below prior to getting started. Please download the form, complete it and bring it to your first visit. If you are not able to complete these forms prior to your first visit, please arrive 10 minutes before your scheduled appointment.

The forms are PDFs and require you have Adobe Reader to open them. (Nearly all computers have this. If you cannot open the form, you can download it here: Adobe Reader.)

Patient Information

Patient Form

Medical History

Medical Form

Dental History

Dental Form

Insurance Information

Insurance Form
Smiles By Dr. Heavenly
Smiles by Dr. Heavenly
3840 Peachtree Industrial Blvd, Suite 320
Duluth, GA 30096

Phone: 404-567-6820

Office Hours:
Monday 9:00 AM - 5:00 PM
Tuesday 9:00 AM - 5:00 PM
Wednesday 9:00 AM - 5:00 PM
Thursday 9:00 AM - 5:00 PM
Friday 9:00 AM - 5:00 PM
Schedule Appointment ›

Dental services

Cosmetic Dentistry
Dental Implants
Full-Arch Implants
Porcelain Veneers
Sedation Dentistry
Teeth Whitening

Dental specials

Dental Implant SpecialDental Implant Full Arch Special

Patient information

Financial Information

About us

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