New Patient Forms

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

New Patient Forms
New Patient Forms.pdf
Adobe Acrobat document [173.2 KB]

Existing Patient Forms

Please fill out our yearly, existing patient update before your next appointment to expedite your check-in process in the office.

Patient Update
Patient Update.pdf
Adobe Acrobat document [34.3 KB]


Midlothian Office

14269 Midlothian Tpke

Midlothian, VA 23113

(804) 379-7677 


Powhatan Office

3250 Anderson Hwy

Powhatan, VA 23139



Chester Office

6600 Courtyard Road

Chester, VA 23831



Office Hours

Midlothian: Mon-Fri 8-5

Powhatan: Mon-Fri 8-5

Chester: Mon-Thurs 8-5

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Voted Best Dentist in Richmond 2012, 2013, 2014, 2015, and 2016!
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© Don Murry III DMD