Robert Dillman, D.D.S., Casey Sidders, D.D.S. & Jeremy Lois, D.D.S.

1515 West Main Street  | Whitewater, WI 53190

262.473.3700

New Patients

 

Welcome to our office!

 

For each new patient, please fill out, print and bring the following forms with you to your first appointment.

 

We can also mail forms to you if you'd prefer. Please call our office to make arrangements.

 

If you are unable to do so, please arrive 15 minutes prior to your appointment to fill out the necessary paperwork.

 

 

 

Forms

Patient Information Form

 

Dental History Form

 

Medical History Form

 

 

The following form is optional to print and is for your reference only.

 

Updated Notice of Privacy Practices

 

Updated Notice of Privacy Practices (en español)

 

 

Thank you. We look forward to meeting you and welcoming you into our dental family.

 

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1515 West Main Street

Whitewater, WI 53190

(P) 262.473.3700

(F) 262.473.3718

Whitewater Family Dentistry proudly serves the following areas:

Whitewater, Koshkonong, Fort Atkinson, Hebron, Troy Center, Milton, Edgerton, East Troy, Palmyra, Eagle, and more