New Patient Forms

These forms are mandatory for new patients. To expedite your visit, print these forms, fill them out and bring them with you for your first visit.

New Patient Forms
New Patient Forms w Hippa included(updat[...]
Adobe Acrobat document [292.0 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

(804) 598-2600 


Chester Office

6600 Courtyard Road

Chester, VA 23831

(804) 796-9500 


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