Pine Mountain Family Dentistry
Pine Mountain Family Dentistry

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

New Patient Paperwork.pdf
Adobe Acrobat document [433.6 KB]

Patient Forms

We are required to gather and update patient information before providing patient care.  To expedite your visit, print this form, fill it out and:


  • fax to 706-663-2075
  • save and email to 
  • mail to P.O. Box 1176 or
  • bring it with you for your first visit.


If you are unable to print and complete the forms, you can fill everything out before your appointment; just arrive early enough before your appointment so we can keep you on schedule. 


We look forward to seeing you!

Privacy Policy

Our Privacy Policy is included in the patient forms. We also have our Privacy Policy posted in our office and a copy is available at any time.

Make an Appointment Today!

Where time-honored family values meet the latest dental health technologies!

Pine Mountain   Family Dentistry


8944 Hamilton Road

Pine Mountain, Ga. 31822


Phone: 706-663-2272

Fax:  706-663-2075



Office Hours

Mon-Thurs 8:00 - 5:00

Friday 8:00 - 2:00

Lunch from 1:00 - 2:00

Keep Your Teeth Healthy!

What is the best preventive care for your teeth? Find out how to make your next visit easier and more pleasant.

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