New Patient Forms

Your new patient exam and consultation will take about 90 minutes. You will undergo a safe and fast series of digital X-rays. We may also capture intraoral images of your teeth and gums. Dr. Butler will also perform a complete head and neck cancer screening test as well as a complete charting of existing work and restorations done to your teeth.

Before you leave, Dr. Butler will discuss his findings and any treatment options necessary with you. A formal printed Treatment Plan complete with Finance Options will be given to you for your review and discussion.




Click on links below to download and/or print our New Patient Forms. After completing the forms please MAIL FORMS to:

Carroll R. Butler, DDS
321 W. Water Street
Kerrville, TX 78028

or EMAIL FORMS

Use of Adobe Acrobat is required. If needed, download here for free. Adobe Reader - Free


PRINT the following 6 New Patient Forms. Send or bring these forms to our office PRIOR to your first dental appointment:

•Patient Privacy Consent Form
•Receipt of Patient Privacy Notice
•Confidential Questionnaire
•Medical History
•Dental History
•Financial Policy

•Medical History Update Form (existing patients only)
This form is editable. To access this form click on the link above. You may then type directly into the form. When you are ready to print this form, use the tools at the bottom right of the page. To return to the website, use your BACK button on your browser.

Click on link below to READ or PRINT our Patient Privacy Policy
•Patient Privacy Notice