Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Patient Registration Forms

Medical and Dental History Forms 

To complete your forms online, click the button below to register using our online portal:

 

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

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Send Us A Message

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

PECCOLE FAMILY DENTAL
CREATING BEAUTIFUL SMILES

Las Vegas Dentist, Dr. Shih, Dr. Funamoto, and Dr. Moore are dedicated to family dentistry such as Exams, Teeth Whitening, Veneers and more. We look forward to your visit to our Las Vegas dental office.

2021

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Our Office

7720 W. Sahara AvenueLas Vegas, NV 89117Get Directions(702) 242-6500

2021

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