Patient Forms

Pediatric Dentistry of Coralville isn’t just a dentist office. It’s a place children look forward to visiting and where parents are just as comfortable as the patients. We make sure healthy always comes with a big dose of happy. Pediatric Dentistry of Coralville is Where Smiles Grow.

Waiting room policy:

Parents in treatment area policy: We welcome one parent to come back per patient. Bear in mind, some patients do better without mom or dad in the treatment room. Your child may be better able to focus on treatment instructions. Plus, this gives the dentist, hygienist and your child a chance to form a trusting relationship.

  • Patient Registration

    You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Complete and Send button at the bottom to automatically send us your information. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

    Patient Registration Form
  • Privacy Notice

    This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.

    Download
  • Referring Doctor

    Please use the link below to access our secure online Referral Form.

    Doctor Referral Form

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