New Patient Forms

Visit our team to treat yourself to a dentist that values your time as much as you do! At our Garland, TX dentist office, we allow our new patients to fill out their forms on their schedule so you can spend less time in our reception area.

Just fill out the secure form below and submit it electronically or download and print the PDF to bring to your first appointment.

To book your appointment with Dr. Kerbel, Dr. Callier, and Dr. Margolin, call (972) 278-9901, visit our office in person or use our convenient online form.

My Notice of Privacy Practices

  • Patient Information

  • Name*

  • Date of Birth*

  • Mailing Address

  • Contact Information

  • Employer

  • If Student

  • Driver License

  • Who may we thank you for referring you?

  • Contact in case of emergency

  • Insurance Information

  • Primary Dental Insurance

  • Secondary Dental Insurance

  • Patient Health

  • Patient Condition

    These drugs are used to treat osteoporosis, osteopenia, bone cancer, and post-menopausal bone loss and can cause poor bone healing resulting in osteonecrosis, (death of the bone) which is a very serious and often untreatable complication.
  • Weight and Height

  • Medications

    List all medications you are currently taking, include over-the-counter drugs and herbal supplements*