Tecumseh Dental Center
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PATIENT FORMS
Please download and fill-out our Medical History Form and our New Patient form. After you have completed the form, please make sure to bring it on your first visit to our office. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect it.

Download Our New Patient Information Form
Download Our Patient Insurance Form
Download Our Privacy Practices Form
Download All Three Forms

Technical Note:
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Tecumseh Dental Center
1709 Teal Road Lafayette, In 47905
p: 765 477-6487 • f: 765 477-6488
e: info@tecumsehdentalcenter.com