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When you appear for your first
appointment, it is always best to bring in the following items:
1. A Referral Form from your dentist is appreciated,
but not required. There is a Referral Form link below which allows you or your dentist to obtain a Referral Form immediately.
If your dentist does not have referral forms from my office, please let me know and forms can be mailed to them.
2. Any Xrays taken within the past two years - Preferrably Full Mouth Xrays or a Pan
- Your general dentist can also E-mail the Xrays (if digital) to tck@kelleyperio.com. You can have your general dentist mail them to : Thomas C. Kelley,D.D.S.,M.S.D.,L.L.C.,
17280 W. North Ave., STE
203, Brookfield,
Wisconsin 53045.
3. Dental and Medical Insurance Cards
4. If you require premedication, please take
it as prescribed prior to your appointment.
5. Lastly you may download, print, and complete our new patient
forms before your appointment in order to save time-- just click the links below for the following forms: Patient Registration / Dental & Medical History / HIPAA. Or these forms may be completed in our
office when you come for your appointment.
Referral Form (For DDS)
1. Please Print These Forms-Patient Registration/ Medical & Dental History Forms
2. Please Print These Forms-Hipaa Forms
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Thomas C. Kelley, D.D.S., M.S.D., L.L.C.
Two
Locations:
Norcal
Professional Center
17280 West North Avenue, Suite 203
Brookfield, WI 53045-4366
*Brookfield Office 262-787-9075
* Brookfield Fax 262-787-9076
North Shore Bank Building 3970
North Oakland Avenue, Suite 503 Shorewood, WI 53211 *Shorewood Office 414-964-5400
*Shorewood
Fax 414-964-5401
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