Phone: (620) 899-4784 Fax: (620) 307-3050

Patient Forms

We have made all of our patient forms available to you as Adobe Acrobat files.  For your safety and convenience, we recommend printing and completing these forms in the comfort of your home.  

Note:  Our forms require Adobe Acrobat Reader. If your computer does not have this software, it is available for free download here:

Please remember to bring your completed forms with you for your first appointment.  If you have any problem getting these files to print properly, please call our office, and we will gladly send or fax them to you.

All the forms:

Pre-Operative Instructions for Dental Surgery Form  Medical History Update FormMedical Consultation Form Disclosure & Consent--Dental & Oral Surgery Form Nerve Injury Disclosure & ConsentPost-Operative Instructions Following Dental Surgery FormAcknowledgment of Privacy Practices Form

Miscellaneous forms (if required):

Supplemental Disclosure & Consent Form Implant Consent Form Coronectomy Consent FormBisphosphonate Consent FormAnesthesia Consent Form

Contact Dr. Jensen

(620) 899-4784