Fort Lauderdale Dentist - Patient Forms - General and Cosmetic Dentistry

Fort Lauderdale Dentist, Dr. Jeff Bartlett, offers expert cosmetic dentistry, Invisalign, laser dentistry, dental implants and Zoom whitening.

2440 East Sunrise Blvd. Ft. Lauderdale, FL. 33304 (inside the Galleria Mall - between the Gap and Dillards on the back side)

(954) 566-8668

	WELCOME
	MEET DR. BARTLETT
	SMILE GALLERY
	OUR TEAM
	OUR SERVICES
	COSMETIC ANALYSIS
	ANXIETY-FREE DENTISTRY
	ZOOM WHITENING
	LASER DENTISTRY
	ADVANCED TECHNOLOGY
	PATIENT PAMPERING
	PERMANENT MAKEUP
	HOURS & LOCATION
	FINANCE OPTIONS
	APPOINTMENT REQUEST
	PATIENT FORMS
	PATIENT SURVEY
	CONTACT US
	HELPFUL LINKS

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Patient Forms

For your convenience, we have supplied a Health History Form in pdf format. If you wish, click on the link below, print, complete the form at home, and bring it with you to your first visit! We look forward to greeting you! If you prefer, you may register securely ONLINE! Just click the button below.

Patient Registration Form

Adobe Acrobat Free Reader

Appointment Request Ft. Lauderdale Dentist

New Patient Offer

FREE Whitening
for Life!

Receive a complimentary whitening kit and custom trays with completed new patient exam, cleaning, and x-rays. Keep your 6-month recare visits and you will receive additional gel annually for the rest of your life! ACT NOW to take advantage of this amazing offer, simply complete the form provided and click on send info. Thank you.

<table border="0" cellspacing="3" cellpadding="3" align="center"> <tbody> <tr> <td> <p style="text-align: center;"><strong><span style="font-size: medium; color: #ff0000;"><em>New Patient Offer</em></span></strong></p> <p style="text-align: center;"><strong><span style="font-size: small;">FREE Whitening <br />for Life!</span></strong></p> <p>Receive a complimentary whitening kit and custom trays with completed new patient exam, cleaning, and x-rays. Keep your 6-month recare visits and you will receive additional gel annually for the rest of your life! ACT NOW to take advantage of this amazing offer, simply complete the form provided and click on send info. Thank you.</p> </td> </tr> </tbody> </table>
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Ft. Lauderdale Dentist · Jeff Bartlet DDS · 2440 East Sunrise Blvd · Ft. Lauderdale, FL · 33304