(219) 779-9114 Appointment

New Patient Forms
in Crown Point

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

HIPAA Policy

HIPAA Acknowledgement Form

Adult Dental History Form

Adult Medical History Form

Child Medical History Form

Payment Arrangements

Financial Policy

10705 Randolph St., Crown Point, IN 46307

Our smile specialists are ready to make sure your smile is as healthy as possible. We offer treatments to meet your every dental need and customized plans tailored to your smile. At Dental Image, we believe everyone deserves a healthy, happy smile. Make an appointment today and let us help you find yours.