Patient Forms

For the convenience of our patients, Cummins Dental Group has provided the necessary forms for our patients to print and fill out at their leisure before their appointment. If you have any questions about the content of the forms, or any other concerns regarding our procedures, office hours, or other, please don't hesitate to give us a call at (301) 681-9111 and our front desk staff will be happy to assist you.

 

 

New Patient History Form

 

Medical History Form

 

Notice of Privacy Practices

 

Release of Health Information

 

Consent to Dental Photography

Appointment request
Need an appointment with a dentist in Silver Spring ? Requesting an appointment at our Silver Spring, MD family and cosmetic dental office is now easier than ever. Fill out the form below and we'll contact you to find a time that fits your schedule. Start your journey towards a beautiful smile with us today!
Patient Name*
Phone Number*
Email Address
Are you a current patient?
Best time(s) to call?
Preferred Appt Date
Preferred Appt Time
Message
Describe the nature of your appointment or any other comments