Are you a current patient at Pike Lake Dental Center?
We want to stay up to date with all your information, including your health history, medications, insurance policy, phone numbers and address.
If it’s been over 12 months since you last completed any of these forms, please take a few moments to fill them out online. Once completed, each form will automatically be returned to us.
Parents, don’t forget to fill out a form for each member of your family.
Thank you!
Each new year, we ask you to complete our most current Medical History form. It is exteremely important for us to know your medical history information. Don’t forget about your current medications!
Do you have Dental Insurance? Then this form is for you! This form tells us your current address, phone number, dental insurance and more.
No Dental Insurance? This form is for you! You get to skip filling out extra information. This form tells us your current address, phone number and more.
This form is an important one. If we can’t get ahold of you or there is an emergency in our office we need to know who to call. Don’t skip filling out this form.
This form is for everyone! It covers our office’s Privacy Practices, letting you know how we keep your information safe and secure. This is an important form to acknowledge.
Do you want your current x rays to come to us from another office? Please fill out this form and we will request any current films from another office to come to us. Don’t forget to include your birthdate!
Do you want you films to go to another dentist or dental center? Please fill out this form and we will send any current films to the office of your choice. Please include your birthdate.
Are you having dental treatment you’d like us to highlight on our website, in office or on Social Media? If so, please fill out this form and we can show off your beautiful smile, new crown, bridge or Invisalign treatment. We love to take before and after photos too!
Pike Lake Dental Center
5651 Miller Trunk Hwy
Duluth, MN 55811
Hours
Monday- Thursday: 7:30am – 5:00pm
