New Patient Forms

New Patient Forms

Welcome to 101st Adult Dentistry! Our new patient forms are available for you to download. To expedite your treatment time, please print, complete all five forms, and bring to your appointment. 

Requires Adobe Acrobat Reader

Patient Registration

Health History

HIPAA

Financial Agreement

Missed Appointment

Patient Reviews

"I LOVE 101st Dentistry!!!! Kim is totally wonderful! I truly look forward to my Dentist appointment each 6 months!!! Thank you!"

"The staff at 101st are very caring and professional. Dr Hnarakis and Britton make sure you are comfortable with them before they work. All the staff treat you like family! Thanks to all of you for caring for your clients."

"I have never had a bad experience here. I have bad anxiety about a dentist but since day one they have always made me feel comfortable. If you want a outstanding dentist, a place that will put your needs/concerns first then you have found the place. I promise you will not be disappointed."

member of the american dental association
Member of the Tennessee Dental Association
academy of general dentistry member
Care Credit Dental Financing