104 W. 20th St., Suite 3
Eudora, KS 66025

New Patient Information

Your comfort is our first priority

We want your visit to the dentist to be as pleasant as possible.

Your First Visit

So that your first visit can be as brief as possible, there are a few things you should bring with you. Download the new patient forms below, fill them out, and bring them to your first appointment along with any dental insurance documentation.

Patient Registration (PDF) >
This form includes your patient contact information, dental and medical history, and dental insurance information.

Records Request (PDF) >
This form authorizes our practice to request your dental records from your current dental provider.

Consent Form-HIPAA (PDF) >
This form authorizes John H. Hay, DDS to access your medical records during treatment.

Notice of Privacy Practices-HIPAA (PDF) >
This notice describes how health information about you may be used and disclosed and how you can get access to your health information.

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 What to Expect

  • Dr. Hay will perform a complete oral examination, identify any conditions such as tooth decay or periodontal disease, and screen for oral cancer.
  • Teeth cleaning might be performed during your first visit, or might be scheduled for a follow-up visit depending on the condition of your teeth and gums.
  • Your first appointment will take about an hour.
  • Patients under the age of 18 must be accompanied by a parent.

Appointment Cancellation

If you find that you cannot make your scheduled appointment, please call our office at least 24 hours in advance at 785-542-9105 to reschedule.