If you are a new patient. Fill out the forms below and bring them for your appointment.
This form covers basic medical information that we will need in order to best serve you.
Patient contact and insurance information form.
If you have dental insurance, we will help you to receive your maximum allowable benefits. In order to do this, we need your assistance and your understanding of our financial policy.
Acknowledgement of Receipt
Acknowledgement of receipt of notice of privacy practices.
Meet Dr. Self
We would love the opportunity to welcome you into our family of patients.
WEST TENNESSEE DENTAL GROUP
174 Community Park Road Dyersburg, TN 38024