Thank you for choosing Rockville Smiles. We are looking forward to treating you. For convenience sake and to make your appointment easier, we would like to capture information for your chart and our staff prior to you seeing our dental providers. We have two easy ways for you to give us your information.
1. Our on-line form: Click Here: New Patient Registration to access it.
The electronic form is for Pedo Patients only. NOT to be used for orthodontic appointments.
2. If you aren't interested in filling out your information on-line, we have PDF forms you can print, fill out and bring with you to your appointment:
• Health History Form - English
• Health History Form - Spanish
• Patient Information - English
• Patient Information - Spanish