Patient Forms, Map and Directions to Our Office

We welcome New Patients for more assistance: Call (419) 422-8972

Your first visit to DeClerck Family Dental involves a few special steps so that we can get to know you. In order for you to understand what to expect, please read through this page. You'll find all the practical information you need such as a map and directions to our office, practice hours, payment policies and more. There's also background information about our committed dentist and our first visit procedures. You can save time by printing out and completing the patient forms in advance of your appointment. Please just print out and bring completed forms to your first appointment.

Mission Statement
Our practice is working together to realize a shared vision of uncompromising excellence in dentistry.

To fulfill this mission, we are committed to:

• Listening to those we are privileged to serve.
• Earning the trust and respect of our patients, profession and community.
• Exceeding your expectations.
• Ensuring a caring and compassionate professional environment.
• Striving for continuous improvement at all levels.

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Patient Forms
Please print, fill out and bring these forms to your first appointment to expedite your visit.

• New Patient Forms
• Medical History Form

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

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What To Expect
Being well-prepared for your appointment will ensure that the dentist has all of the needed information to provide the best possible care for you. It also will help relieve any unnecessary anxiety you may be feeling. Educate yourself on your symptoms by reviewing the content on this Web site. Also, take some time to review our staff page and familiarize yourself with the doctor. We look forward to your first visit.

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