New Patient Registration Forms

We recognize that your time is valuable. We will make every attempt to see you at your scheduled appointment time. To save time, download our New Patient Registration Form. This may be easily completed using your keyboard and mouse. Print the completed form and fax it to us or bring it with you to your first appointment.

To print our New Patient Registration Form, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

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120 Office Park Drive Suite 240, Mountain Brook, Alabama 35223
P: 205.423.9140 | F: 205.870.4040 | Email: office@MountainBrookSmiles.com
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Dr. Wes Samford is a family, cosmetic, and restorative dentist who welcomes new patients from all over including Mountain Brook, Birmingham, Hollywood, Cherokee Forest, English Village, and Rosedale.