Patient Forms

We Specialize in Full Sedation Dentistry

Patient Caregiver New Patient Forms
Patient or Caregiver

New Patient Forms

Please fill out the New Patient Forms prior to your first appointment. It is very important that these forms be completed in advance.
Referring Physicians

Referral Slips

Thank you for referring your patients to the Center for Dental Rehabilitation. We’re honored in your trust, and we’ll take excellent care of your referral. No case is too challenging for us!

Referring Physicians-Referral Slips Patient Forms

Because most of Dr. Toal’s patients are under some form of anesthesia, she requires that all of our work be done to the highest level.

Sean Marchal

Owner, Lafayette Dental Lab

Dr. Toal approached me about setting up her own operating rooms. Her primary interest was in creating the safest possible environment.

Dr. Smith

Medical Anesthesiologist

It’s very safe. We go through drills on a regular basis. Everybody knows their role if there’s an emergency. Everybody knows what they’re doing.

Bits Schaedel

Registered Nurse

dr Maureen Toal
A Message from Dr. Toal

Keeping You Well

The relationship we establish with each and every one of our patients is viewed with a deep sense of responsibility. A major part of that responsibility is to help our patients get back to receiving regular dental care. Once a treatment plan has been established, our goal is to restore optimum dental health in a few, well-planned appointments at your convenience.

During your first visit, you will receive a thorough examination of your mouth, teeth, gums and soft tissue. The examination will include necessary diagnostic radiographs to accurately determine the condition of your oral health. Following a careful diagnosis, we will consult with you to insure there is a full understanding of your dental needs, the procedures recommended and the possible consequences if the necessary dentistry is not addressed.

Please complete and sign the enclosed forms and bring them to your appointment. If you have dental or medical coverage, we will be happy to submit claims for your reimbursement. Therefore, please remember to bring your complete insurance information.

Thank you for choosing the Center for Dental Rehabilitation to serve you. We look forward to working with you.