Patient Forms

At Delaware Periodontics, Dr. Klassman and our team strive to deliver optimum care for patients in and around Dover and Wilmington, Delaware. In order to deliver such outstanding care, we require each patient to provide their medical history and records. Providing us with such information will enable us to structure our periodontal treatments to fit your medical needs and comprehend your oral hygiene habits.

We appreciate you taking the time to fill out these forms. Once you have completed them, you may bring them to your appointment, fax them to 302.652.6294, or mail them to our Wilmington office at 1110 N. Bancroft Pkwy, 19805.

If you cannot submit the forms online or do not want to download Adobe Acrobat Reader, please feel free to print our forms below, fill them out, and bring them to our office.

  • Patient Information Form PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

Thank You For Choosing Delaware Periodontics!

Welcome to the Delaware Periodontics dental family! Our friendly staff is happy to address any questions you might have and guide you to our office for your first visit. If you haven’t done so, feel free to book an appointment online today!