Patient Forms, Map and Directions to Vernon Office
Your first visit to Jeffrey Burns, D.M.D. establishes a vital foundation for our relationship with you. During the first visit, we make sure to obtain important background information, like your medical history, and give you time to get to know your doctor. To understand what to expect for your first visit to our practice, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can even save some time at your first visit by printing out and completing the patient forms in advance of your appointment.
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve.
- Earn the trust and respect of patients, profession and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.
Please print and fill out these forms so we can expedite your first visit:
- New Patient Registration
- Medical History
- Authorization to Release Information to Dr. Burns
- Authorization to Release Information to a Third Party
- Authorization to Pay Benefits
- Acknowledgement Form for Receipt of Notice of Privacy Practices
- HIPAA Notice of Privacy Practices
- Smile Evaluation
- Current Patient Update
- Appointment Request
- Refer A Patient
In order to view or print these forms you will need Adobe Acrobat Reader installed.
Click here to download it.
What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctors. We look forward to your first visit.