Couchman Center for Complete Dentistry
Donald Couchman, DDS
Creating Beautiful Smiles
Call: (719) 593-0263

New Patient Forms

Colorado Springs Dentistry - Donald Couchman, DDS

We know that your time is valuable and because we want you to spend more time with the dentist and less time in the waiting room, we have uploaded forms for new patients to our website. All of these forms need to be filled out so we can register you as an official patient in our office.

Prior to your arrival we ask that you print the forms, fill them out, and make sure to bring them with you so we can attend to your Colorado Springs dentistry needs more efficiently and quickly. Feel free to speak with our staff about what we’ve done to make sure your records stay confidential. Thank you, and please call our office if you have any questions. We welcome you to Couchman Center for Complete Dentistry and look forward to meeting with you.

Patient Information Form

Health History Form

HIPPA Consent Form

Financial Policy Form

Filing Your Dental Insurance Form


This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


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