Patient Forms

New Patients:

If you are a new patient, please download and print:

Patient Information Form

Medical History Form

Oral Health History Form

Agreement and Financial Policy

Privacy Authorization Form

Privacy Policies Notice (Retain Copy for your Records)

 

Returning Patients:

If you are a returning patient and have been asked to complete an update, click the links below. (PDF will open in new window)

Patient Information & Medical History Update Form

 

If you would like to return these forms by email, please scan them and send them via email.

 

Additional Forms:

A Word to Our Patients with Insurance

Broken Appointment Policy



Our forms require Adobe Reader to view and print. If you do not have Adobe, please download the Reader here.

Download Adobe Reader

  

Experienced Dental Care

Book your appointment today

Appointments

Contact us today to book your appointment at Del Ray Smiles.

P: 703-836-2213 Appointment Request
Our Location

4 Herbert Street Alexandria, VA 22305Get Directions703-836-2213

Contact Us

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the contact form below.

Alexandria Dentist, Dr. Julie Tran is dedicated to excellence in general dentistry such as cleanings, restorations, and maintenance.

2025 Del Ray Smiles
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