New Patient

Click the pdf files below to access the new patient forms. Please print and complete the three forms prior to your visit, and bring them with you to hand to our office staff upon arrival.

new patient form




"Dr. Bleak is an excellent Dentist. I am extremely fussy about who I allow to treat me. This doctor has a wonderful personality, that immediately relaxes the patient. Any nerves that may be on edge, with any dentist, are soon diffused by the pleasant people who work in the office, as well the doctor himself. I believe that Dr. Bleak is an excellent dentist, and definitely places the comfort of the patient first. I would highly recommend him to anyone in my family. The results of the dental work itself have been outstanding. I am a senior citizen and have been very well experienced with dental work, and his work as well as equipment is superior."

- C.B.

"Came in for a difficult extraction of a broken wisdom tooth. I can not recall a time when I felt more welcomed and truly taken care of by a doctor and their staff. Extremely grateful to everyone there"

- H.B.

"I've always been apprehensive when it comes to anything dental, this office change my perspective, from the moment you call the office, the staff is extremely warm, professional, friendly, very supportive, Meeting Dr. Bleak had change my life, from the moment I step in, he was very informative, reassuring, gentle, he explained every procedure to me in great detail, and presented me with all my options, he alleviated any fear, or concerns I have, because of his patience, I managed to remain calm which was never a word I associated before in a dental visit. I highly recommend Dr. Bleak and his staff, your smile and your life will definitely improve. 5+ Stars!"

- C.A.