Patient Forms | Dentist in Charleston & Hurricane, WV

We have provided our patient forms online for your convenience, and we encourage you to fill them out before your appointment with our dentists in Charleston, West Virginia, and Hurricane, West Virginia. This will save you time in our office and streamline your appointment with Drs. John Falbo, Daniel Monday, or Stephen Graziani. If you have questions, please call our office. We will be happy to help you.

*Online Forms are only available through the Google Chrome web-browser.
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Adult Patient Form

Child Patient Form

Privacy Practices

Dental Questionnaire

Authorization Release

Dentures in a Day

Dentures in a Day

Our All-On-4 implant-supported dentures can give you back a confident, beautiful smile in just one day! Call us today to schedule your consultation!

Implant Reconstruction

Implant Reconstruction

Implant dentistry helps to reconstruct your smile and improve your quality of life by replacing missing or damaged teeth. Call today to learn more!

Root Canals

Root Canals

Our dentists offer root canal therapy to remove infection and preserve your teeth. Give us a call today to learn more and make your appointment!

Diode Laser Dentistry

Diode Laser Dentistry

Our dentists use a Diode soft tissue laser to provide you with precise, comfortable treatments. Contact us today to schedule your laser dentistry consultation.

Get Directions

CHARLESTON OFFICE:

1213 Virginia St E
Charleston, WV 25301

HOURS:

Monday - Friday
8:00 am - 4:30 pm

Get Directions

HURRICANE OFFICE:

2939 Virginia Avenue
Hurricane, WV 25526

HOURS:

Monday - Friday
8:00 am - 4:30 pm