Thank you for choosing Dr. Ben Johnson as your dentist.  Please complete the following new patient form below prior to your first visit.

NEW PATIENT FORM
RESPONSIBLE PARTY
DENTAL INSURANCE INFORMATION
PATIENT MEDICAL HISTORY
FOR WOMEN ONLY
PATIENT DENTAL HISTORY
AUTHORIZATION AND RELEASE
I certify that I have read and understand the above information to the best of my knowledge. The above questions have been accurately answered, I understand that providing incorrect information can be dangerous to my health. I agree to be responsible for payment all services rendered on my behalf or my dependents.
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Call Us For An Appointment

Phone: (270) 554-2432

Working Hours

Monday-Thursday 8am-5pm
Friday – By appointment only.

Our Address

2913 Lone Oak Rd
Paducah, KY  42003