New Patient Forms

Please print and fill out forms prior to coming into the office. This will make sure that you are seen as quickly as possible.
Click on the forms below to download and print.

X-Ray Release Form
Broken Appointment Form
Financial Guidelines Form
HIPAA
Medical History
Registration Form

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and as a thank you, you and the referral will receive a $25 credit to use on your next visit.

Kennestone Dental Designs: Dr. Barry P. Smith, DDS 709 Canton Road NE, Suite 210, Marietta, Ga., 30060 | Map & Directions

Phone: 770.426.4188| Email: info@kennestonedentaldesigns.com

Kennestone Dental Designs is dedicated to providing you and your family the comprehensive, comfortable and convenient dental care you deserve. We are enthusiastic about educating our patients and working together with them to attain healthy, functional and beautiful smiles. Our professional and courteous dental practice is committed to helping you achieve the best oral health for a lifetime.

New Patient Forms

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Make An Appointment

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