Appointments and New Patient Information

We Welcome New Patients!

Call us at 817-481-6364 so we may be of service to you. For your convenience, we have made New Patient Registration Forms available to you online as Adobe Acrobat files. We recommend printing and completing these forms at home. Please remember to bring your completed forms with you for your first appointment with us. If you experience any problem getting these files to print properly, please call our Southlake dental office at 817.481.6364 and we will gladly send or fax them to you.

• Patient Forms Online
• Patient Registration Forms (Downloadable)
• Financial Policy
• Insurance
  
• Privacy Practices Acknowledgement

Request to Transfer Medical Records

• Click here to download our authorization to release x-rays and dental information form.

About Insurance

Insurance claims are filed by John Michael Tate, DDS, PA as a courtesy to you.

Rescheduling Appointments

Please provide a minimum of 24 hours notice if you must reschedule or cancel an appointment (a fee may be charged for less than 24 hours notice).

Prescription Refills

Please provide your pharmacy number and location when calling for refills.

Back to Top

Personal Appointment

Name
Phone Number
E-Mail Address
Preferred day of the week MON TUE WED THU FRI
Preferred time of day		a.m. p.m.
How did you hear about us?		-Search EngineFamily / FriendOther
Please review the information you are about to submit for accuracy. Thank you!