New Patient Forms

Contact Us!

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

 
 
Office location:
Arlington
800 West Arbrook Blvd
Suite 360
Arlington, TX
76015
Phone: 817.467.7731

The first visit to our office is designed to get you better acquainted with all we offer as well as introduce you to Dr. Boltchi and our caring team. We encourage questions and do our best to always deliver quality care.

Please take a moment prior to your scheduled appointment to download our patient forms. We ask that you complete the forms and bring them with you to your appointment.

REGISTRATION FORM

MEDICAL HISTORY

DENTAL HISTORY

HIPPA Acknowledge

Medication List

TRANSFERRING TO DR. BOLTCHI

If you are transferring to our office from another periodontal  or oral surgeons office, please print out the following form to fax or mail to the office that you will be transferring from.

TRANSFER Records

 

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


ACCESSIBILITY