New Patient Forms

Below is a link to fill out your new patient information online.  This saves time and allows us to have your information entered prior to your first appointment.  Some sections (such as the Responsible Party section or the Dental Insurance section) can be left blank if they do not apply to you.  MAKE SURE TO FILL OUT BOTH THE NEW PATIENT FORM AND THE MEDICAL HISTORY FORM AFTER CLICKING THE LINK BELOW!

If you do not feel comfortable filling out the forms online, you can fill them out on an iPad prior to your first visit- plan on arriving 15-20 minutes prior to your scheduled appointment time to fill out the forms if you have not done so online.

Also, feel free to download the Notice of Privacy Practces and HIPPAA forms which explain our privacy policies and compliance with federal HIPAA guidelines.

Please give us a call if you have any questions!

New Patient Forms (Online Version)

New patients- Make sure to fill out BOTH the new patient forms and the medical history form.

Notice of Privacy Practices


Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (610) 539-8425
View the ADA Accessibility Statement
In response to the ADA and Pennsylvania Department of Health recommendations regarding the COVID-19 virus, our office will be temporarily closed until further notice. We will continue to check messages and respond to emails during this time. Current patients of record with a dental emergency will be able to speak with Dr. Wahlers by phone (call the office and listen to the recorded message) and may be seen depending upon the circumstances. New and existing patients are also welcome to call or email to schedule future appointments. Thank you so much for your understanding.