Patient Form Downloads


Patient Center/Patient Form Downloads

Patient Form Downloads

For your convenience, all new patient paperwork can be accessed online. Simply download each form below, complete the forms at home, and bring the forms with you to your first appointment. If you should have any difficulty downloading these forms, please call our office and a knowledgeable staff member will be happy to assist you.

 

Financial Agreement Form

HIPPA Privacy Practices

HIPPA Privacy Notice Form

Independent Hygiene Form

Patient Health History Form Part 1

Patient Health History Form Part 2

Dr. Robert Franklin, a periodontist in Elizabethtown, Kentucky, specializes in the diagnosis and treatment of periodontal disease. Dr. Franklin welcomes patients from Elizabethtown, KY; Radcliff, KY; Louisville, KY; Bardstown, KY; Bowling Green, KY; Campbellsville, KY; Lebanon, KY; and Springfield, KY as well as the surrounding areas. Our office offers advanced dental treatments including the LANAP Laser Treatment for periodontal disease, Pinhole Surgical Technique™ for gum recession, gum grafting, osseous surgery, and bone grafting. Call (270) 600-6394 to schedule your appointment or click here to request an appointment online!

Have Additional Questions? Call Now: (270) 600-6394

Ready to Schedule Your Appointment?
Click Here! 

Contact Us

Elizabethtown Periodontics
Dr. Robert Franklin
611 W. Poplar Street
Elizabethtown, KY 42701
New Patients: 270-600-6394
Current Patients: 270-769-1622
Fax: 270-766-1044
etownperio@gmail.com

Business Hours:
Tuesday through Thursday –
8:00 a.m. to 4:30 p.m.
Friday – 8:00 a.m. to 3:30 p.m.

Ask the Doctor

Name:
Email:
Phone:
Message:

Enter the code shown above: