New Patient Info

Patient Forms - Franklin Street Dental

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all at (812) 424-6761.

Patient Registration Form

Medical History

Privacy Acknowledgement

Privacy Notice


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.

Payment Options

For your convenience, we accept cash, personal checks, money orders and major credit cards. Payment is expected at the time services are performed. When more extensive dental care is necessary, financial arrangements can be made with our office.

 Office hours

 Monday through Thursday 8am - 4pm

 Friday 7am - 12pm


We will assist patients with insurance research and any necessary pre-determination of benefits.
We will file pre-determination of forms whenever required.

As a courtesy, we will file your insurance claims. However, any estimated patient balance due is expected at the time of service.

We do not accept Medicaid or Medicare.

We encourage you to contact us with any questions or comments you have by calling us at (812) 424-6761

Contact Us. We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

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Franklin Street Dentistry
2300 W Franklin St Evansville, IN 47712
Phone: (812) 424-6761 URL of Map