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Meadowgate Family Dental
 Jack M. Dorkhom, DMD 
Family and Cosmetic Dentistry
Call (585) 586-8895

Patient Forms

If you are a new patient to our office, below you will find our new patient forms. Thank you and please call our office if you have any questions at all.

New Patient Forms (all inclusive)
Covid Wellness Form
Medical History Form
Patient information Form
HIPAA Forms
Financial Policy


This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

Testimonials

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Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

Office Location

  • Pittsford
  • 101 Sully’s Trail Building 10
  • Suite 11
  • Pittsford, NY
  • 14534
  • Map & Directions
  • Call: (585) 586-8895