Patient Forms, Map and Directions to Keokuk Office
Your first visit to Kircher Family Dentistry involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. You'll find all the practical information you need, such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed staff and our first visit procedures. You can also save some time by printing out and completing the patient forms in advance of your appointment.
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.
To fulfill this mission, we are committed to:
- Listening to those we are privileged to serve.
- Earn the trust and respect of patients, profession and community.
- Exceed your expectations.
- Ensure a creative, challenging and compassionate professional environment.
- Strive for continuous improvement at all levels.
Please print and fill out these forms so we can expedite your first visit:
- Health History Form
- HIPAA Form
- Dental Insurance Information Form
- Financial Agreement Form
- Records Release Form
Click here to download it.
What To Expect
Being well-prepared for your appointment will ensure that the doctor has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Please bring all new patient paperwork as well as an updated medication list and your dental insurance card with you to your appointment. Please note: WE ARE NOT PROVIDERS AND DO NOT ACCEPT ANY MEDICARE DENTAL INSURANCES.