Dentist Columbus, GA



Patient Forms

For your convenience, you can print out and complete our new patient forms at home before visiting the dental office. Although it's not required, bringing the completed forms with you will save time and help make your first appointment faster and easier. Simply bring your completed forms with you when you come for your appointment and present
them to the receptionist when you sign in.

  New Patient Information / Health History Form

  Office Policies (Financial, Insurance, Appointment)

 Privacy Policy (Notice of Privacy Practices)

 Privacy Policy Acknowledgement

 Authorization to Release and Discuss Dental Information

 Authorization for Release/Use of Protected Health Information
        In the Form of Photos, Radiographs, and Electronic Images

In order to view or print these forms you will need a current version of Adobe Reader installed on your computer. If you cannot view or print the forms, simply click the link below to download or update Adobe Reader for FREE.

Download Adobe Acrobat Reader

If you still have any problems with viewing and printing the forms, simply call our office and we will gladly mail or fax the forms to you.


New Patients
For your convenience, you may print a
copy of our new patient form to complete
prior to your first visit appointment.

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Copyright © 2012. All rights reserved.
Family Dentistry of Columbus
Dr. Marlon Murrell, DMD • Dr. Jay Polk, DMD • Dr. Tommy Parker, DMD
3408-B University Avenue • Columbus, GA 31907 • Phone 706.563.5516 • Fax 706.563.5575

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