(636) 206-4656

Patient Forms

Patient Forms

Going to the dentist can be an overwhelming experience, especially on your first dental visit. Let us put your concerns and anxieties to rest. Our goal at Chesterfield Hilltown Dental is to make every patient experience as comfortable as possible.

To make your visit as pleasant and brief as possible, there are a few things you should bring with you. Please bring any dental X-rays from the last six months to your first appointment.

With just a few simple forms, we’ll ask for relevant medical history, any medications you might be taking, your dental history, and any dental insurance coverage you may have.

Want to get a head start? Download the new patient forms below.

These documents are in Adobe PDF format. If you’re unable to read PDF files, please  download free Adobe Acrobat Reader here.

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Our Happy Patients

"Our family (my wife and I, our kids, and our grandson) saw Dr. Alan and Diane and now Drs. Andrew and Carissa. We’ve received nothing but stellar care for many years. Chris and the assistants provide the quality service you expect from a family-owned business. They get my highest recommendation!"

Jerry M.

"Excellent team of dental professionals here, you are always greeted with a smile and receive excellent service with state of the art equipment and expertise. The whole family looks forward to our visits, especially the kids!"

Blake G.

"Our family has the best dentist! They do such a great job at cleaning our teeth and they are so gentle too. My 7 year old and 10 year old actually enjoy going! No pain or sourness and they leave with a toothbrush, toothpaste, toy, & a sparkling smile. Dr. Bruening is so kind and is such a great listener. We recommend him to everyone."

Jackie S.
We're here to help you get the perfect smile!
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