Wayne Dunn and Associates in Parkersburg, WV
Parkersburg, WV dentists Wayne Dunn and Associates
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 Patient Forms
If you would like to complete your registration forms before you arrive, you may download them by clicking below. The forms are in PDF format. If you do not have Acrobat Reader, get a free copy by clicking on the link below. form

Adobe PDFAdobe ReaderNew Patient Form (Acrobat PDF form)

Adobe PDFDental Insurance Authorization Form (Acrobat PDF form)

If you have x-rays and records at another dental office and would like to transfer them to us, please download and fill out the appropriate form below then mail it to the dental office which is holding your records.
Adobe PDFRecords Transfer Form (Single)

Adobe PDFRecords Transfer Form (Family)

Adobe PDFAlso, after reading the Notice of Privacy Practices, print the Acknowledgement form below, sign it, and bring it in along with our signed Financial Policy:

Adobe PDFAcknowledgement of Receipt of Notice of Privacy Practices (Acrobat PDF form)

Adobe PDFFinancial Policy (Acrobat PDF form)

Adobe PDFCOVID-19 Forms (Acrobat PDF form)