Distinctive Dentistry
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Information and downloadable forms for our patients.

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For your convenience, this page includes forms that you may want to download, print at home and fill out before your first visit.   If you choose  to fill these out at the office instead, we are happy to provide them for you, but please arrive 20 minutes early in order to fill out the new patient forms.
​Note: These forms are for first time patients only. 


Other information on this page is provided for our patient's information and knowledge. Please contact us if you have any questions regarding any of the information.

New Patient Forms to Print at Home and fill out.
​Please Bring with you to your First Appointment.

Note: You may choose to fill these out at the office, but please arrive 20 minutes early for your first appointment with Dr. Martin to do so . Thank you. 

Medical History Form
File Size: 944 kb
File Type: pdf
Download File

Contact Preference Form
File Size: 357 kb
File Type: pdf
Download File

Insurance Information Form
File Size: 388 kb
File Type: pdf
Download File

HIPPA Form
File Size: 361 kb
File Type: pdf
Download File

HIPPA Policy can be downloaded and reviewed by clicking here. 
Information Release Authorization Form
File Size: 465 kb
File Type: pdf
Download File


Financial Information, Understanding and Agreement
 Download Here to Read, review and Sign.


Information and forms for Medicare RECIPIENTS 

Please download and sign this form and bring to your appointment if you are a Medicare recipient. 
Statement of understanding about Medicare Form
File Size: 1231 kb
File Type: pdf
Download File

Understanding this Medicare Form - Download here.
Understanding what Medicare covers. - Download here. 
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Our Dedication to Your Dental Education
Our Dedication to Your Dental Goals
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Contact us about an appointment by calling our office at 906-774-2505
821 Pyle Dr. Kingsford, MI  49802

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© Distinctive Dentistry
  • Home
  • A Distinctive Practice
    • Your Comfort
    • Your Education
    • Your Personal Dental Plan
  • Services
    • Preventative Services
    • Restorative Services
    • Diagnostic Services
  • Toothbrush Times Blog
  • About
    • Dr. Jeneen Martin
    • Our Team
    • Investments in our Community
  • Forms
  • Contact Us