New Patient Forms

We are happy to offer our patient forms online. Please feel free to print and fill them out at your convenience before your visit.

New Patient Registration

Please download, print and complete this form before your first dental appointment.
Click here to download (66 KB)

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
Click here to download (229 KB)

HIPAA Form

Please download, print and complete this form before your first dental appointment. This form confirms that you read our Notice of Privacy Practices.
Click here to download (295 KB)

 
If you are unable to view the pdf files, please click on the icon below to download and install Adobe Reader:

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  • Morning
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Our Office

Jackson Dental Clinic

345 North Mart Plaza
Jackson, MS 39206
Map & Directions
 
Phone: 601-981-1000
 

Office Hours*:
Monday8:00am-3:30pm
Tuesday 8:00am-3:30pm
Wednesday8:00am-3:30pm
Thursday8:00am-3:30pm


*Walk ins welcome