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New Patient Forms

Your first visit to Breeze Dental Family Dentistry involves a few special steps so that we can get to know you. To understand what to expect, please read through our website. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can also save some time by printing out and completing the patient forms in advance of your appointment.

Please use 'Contact' page if you want to receive new patient forms to print and fill out them, so we can expedite your first visit.

Forms can consist of:

  • Patient Demographics
  • Medical History Form
  • Insurance Policy
  • Financial Agreement
  • HIPAA Policy
  • Record Release

Before first visit:

  • Make a list of questions to ask our office, so you don't forget anything on the day of your appointment. This includes any concerns you have, or oral problems you've been experiencing.
  • If you have dental insurance, remember to bring your insurance card with you.



Contact Us Today!

Serving Fairfax VA, Oakton VA, Vienna VA, Merrifield VA

Contact Us Today!

Serving Fairfax VA, Oakton VA, Vienna VA, Merrifield VA