Please fill out our New Patient Questionnaire prior to your visit, so that we may efficiently serve you upon arrival.

Instructions:

  • Please use a desktop or laptop; smartphones and tablets are not compatible
  • Click HERE to begin
  • Complete all pages of the “new patient information form” for each child (10 total)
  • Hit “submit” when complete

Note: After filling out the first child’s info and beginning the next, please exit out of all windows until you arrive back to our home page. This will avoid any duplicates or mistakes in the system.

If for some reason you are unable to complete the new patient questionnaire online, please arrive 15 minutes before your appointment to finish this information in the office.

Our New Location is Now Open!

Derby City Pediatric Dentistry has moved across the parking lot to 2407 Bush Ridge Drive.
We can't wait to show you DCPD 2.0!