Patient Registration

Thank you for choosing Edgewater Endodontics for your endodontic treatment needs.

For your convenience, please Download our Medical History Form.

Please bring your completed Medical History Form to your scheduled appointment, as well as the following information:

  • Your referral slip and any X-rays if applicable.
  • A list of medications you are presently taking.
  • If you have medical or dental insurance, bring the necessary completed forms. This will save time and allow us to help you process any claims.
  • Your picture ID, such as driver’s license or state issued ID. 

If you have questions or would like additional information, please don’t hesitate to contact us at Edgewater Endodontics Phone Number 352-688-7858.

Technical Note

These forms are in PDF format. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access these forms.