Patient Center
New Patient Forms
Preparing for your first appointment
If you are a new patient, welcome to our office! We will do everything we can to make your experience here the best it can be.
The office of Jason J. Augustine D.D.S., M.S., P.C. is dedicated to the highest quality of Periodontal care in a relaxed and pleasant environment. If you are a new patient, welcome to our office! We will do everything we can to make your experience here the best it can be.
Please download and print our new patient forms and bring them completed to your first appointment.
- New Patient Form 2019
- Medical History form
- Cancellation policy form
- Consent to
Exam form Acknowledgement to privacy practices formFinancial policy notice form
We accept most major insurance programs.
Accepted Insurance List
Please check with your insurance provider to make sure our office is In-Network with your plan.
Ready To Schedule A Consult?
4025 W. Bell Road Suite #4
Phoenix, AZ 85053
» Get Directions
New Patients: (480) 744-3881
Existing Patients: (602) 978-6910
Fax: 602-978-6920