Patient Forms

If you are a new patient to our office, you may complete the patient forms when you arrive at our office or you could print them out, complete them and bring them with you to your appointment. This will allow us to attend to your medical needs more quickly than completing them on your arrival. Please let us know if you have any questions. 

Patient Forms

Health History Form

HIPPA Consent Form

Financial Policy Form

Filing Your Dental Insurance Form

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Couchman Center for Complete Dentistry
Creating Beautiful Smiles

The team at Couchman Center for Complete Dentistry have been dedicated to excellence in general & cosmetic dentistry services since 1976. When you look for a Colorado Springs Colorado dentist choose Couchman Center. .

Couchman Center for Complete Dentistry
5145 Centennial Blvd., Suite 100 Colorado Springs, Colorado 80919
Phone: (719) 593-0263 URL of Map