Blossom Dental and Facial Aesthetics
Same-day emergency appointmentsDental emergency? (386) 947-7603
900 W. Granada Blvd., Unit 5, Ormond Beach, FL
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Patient hub
Patient forms
Less paperwork on visit day
Pre-register online before your first visit. Your information goes straight into our system, so there's nothing to fill out again when you arrive.
Overview
Pre-register before your visit
You can pre-register with our office by completing the forms below and pressing Submit when you're done. Your information goes straight into our system, so you won't need to fill it out again at your first visit.
All online submissions are encrypted to protect your privacy. If you have any questions about your forms, call us at (386) 947-7603 and we'll be glad to help.
Online forms
Fill out your forms online
Each form opens in a secure window. Press Submit when you are done, and your details go straight into our system.
New patients
New patient registration form
Pre-register with our office before your first visit.
New patients
Dental release form: new patients
Authorizes the release of your dental records to Blossom Dental.
Existing patients
Dental release form: existing patients
Authorizes the release of your dental records from Blossom Dental.
How it works
How it works
01
Choose your forms
New patients complete the registration, medical history and dental release forms. Existing patients can use the dental release form to share their records.
02
Fill out and submit
Complete each form online and press Submit. Your details go straight into our system, and every submission is encrypted.
03
Get ready for your visit
Gather the items listed below. Email any X-rays from the past year to office@blossom-dental.com before your appointment.
For your first visit, please provide
A few details help us understand your health and plan your care. Please have these ready before your first appointment.
- Your full medical and dental history
- A list of the medications you currently take
- Any X-rays from the past year, emailed to office@blossom-dental.com before your visit
- Your insurance forms and your dental and medical benefit cards, brought to your appointment
Patients under 18
All patients under 18 must be accompanied by a parent or guardian at the consultation appointment. If you have questions about bringing your child in, call us at (386) 947-7603.
Sharing your records
New patients can use the dental release form to authorize the release of their dental records to Blossom Dental. Existing patients can use a separate release form to authorize the release of their records from Blossom Dental.
FAQ
Questions about Patient forms
Still wondering about something? Call us at (386) 947-7603 or send us a message, and we'll be glad to help.
Do I need to fill out my forms before my first visit?
Filling them out ahead of time saves you time at your first visit. When you pre-register online, your details go straight into our system, so you won't need to complete them again when you arrive.
Are the online forms private?
Yes. Online form submissions are encrypted to protect your privacy.
How do I get my X-rays and records from my previous dentist to you?
If you've had X-rays taken in the past year, email them to office@blossom-dental.com before your visit. You can also complete the dental release form for new patients, which authorizes the release of your dental records to Blossom Dental.
Do patients under 18 need a parent or guardian?
Yes. All patients under 18 must be accompanied by a parent or guardian at the consultation appointment.
Keep exploring
Helpful links
Insurance
How we work with your dental insurance, plus our discount plans.
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Payment & financing
Cash, checks, major credit cards and financing through three lenders.
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Dental offers
Current specials for new patients.
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FAQ
Quick answers about visits, forms, insurance and emergencies.
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Contact
Call, email or send us a message. We're here to help.
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