New Patient Registration

Happy Faces

Join Our Family

If you would like to register as a patient at Lakewood Dental Smile, you should contact reception and one of the Receptionists will let you know what is required and give you the necessary forms to complete.

Alternatively a Registration Form & New Patient Questionnaire should both be downloaded and printed onto paper from this website. You should complete both of these forms by hand and bring into the practice yourself, with proof of your identity and your address (we require this before we can accept your completed and signed Registration Form & New Patient Questionnaire).

All newly registered patients are asked to complete our New Patient Questionnaire. This enables the practice to have brief information on your medical history, until we receive your medical records from your previous Doctor. Medical treatment is available from the date of initial registration.To assist us with your care, please ensure that we have your up-to-date Telephone Number, Mobile Number & Email Address for you.

To save time you can download all the forms

You need to register from this website

You can download new Registration Form and Acknowledgement of Receipt of Notice of Privacy Practices Form from here.

Smiles to be proud of

Our Dental Patients

About Us

  • 15846 Michigan Ave, Dearborn, MI 48126, United States
  • +1 313-581-1864

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