Ashland City Dental
James Fleenor DMD
Creating Beautiful Smiles
Call: (615) 235-5144

Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Patient Forms

Paperwork

Notice of Privacy Practices (Meant to be read, and kept, by the patient/guardian)

Patient Screening Form-Covid 19

(Print & Complete All Forms Prior To First Office Visit. You may email the completed paperwork to info@ashlandcitydental.com ). 

 

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

Office Location

  • Ashland City
  • 189 Monroe Place
  • Suite 104
  • Ashland City, Tennessee
  • 37015
  • Map & Directions
  • Call: (615) 235-5144