New Patient Information Forms

We have forms that need to be completed before seeing Dr. Bankhead. See below for forms which you can print, fill out at your convenience, and either fax to us at (801) 221-9559 or bring with you at the time of your first appointment.

Click here to view and print the Patient Registration Form

Click here to view and print the Health History Form.

*Adobe Acrobat Reader is nessary to view and print the above forms. If you don't have it click here to download a free copy.

See, We value your mental health as much as your dental health!

1375 East 800 North Suite 104 Orem, UT 84097
1030 East 11400 South Ste 102 Sandy, UT 84094
Monday - Thursday 8am - 5pm & Friday 7am - 3pm
office: 801.221.7799
fax: 801.221.9559
© 2013 Dr. Alex Bankhead :: Utah Valley Periodontics