Patient Forms

Help us get to know you!

Please take a moment to fill out our patient information form. If you have any questions along the way, feel free to contact our office.

Our practice takes strict care to ensure full HIPAA compliance. Rest assured that your privacy is a top priority for Whitley Family Dental. Please read our Notice of Privacy Practices as well as our Financial Agreement below.

Since we are a paperless office, we support our patients who want to fill out their patient form securely online by offering an Online Patient Information Form. Please click here.

For patients who would like to complete and print their forms manually prior to their appointment, use the attachments below.

  • Patient Information Form PDF
  • Existing Patients - Updates Only PDF
  • Notice of Privacy Practices PDF
  • Financial Agreement PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free. 

We look forward to meeting you at your first appointment.

  • “Dr. Bill is the best dentist ever! He is super nice and never makes my teeth hurt. He should really help all the kids when their teeth have booboos.”

    – Laci L. (5 years old)

  • “Dr. Whitley has always been honest, friendly and compassionate about what he does! He has on more than one occasion stayed after hours to help one of my family members out.”

    – Rick & Kelli L.

  • “Dr. Whitley and his staff quickly earned my trust. From the first moment I walked into their office, I was blessed with a sense of security and confidence that I would be well taken care of.”

    – Susan M.

  • “I just got my teeth cleaned by the most wonderful dentist ever! All the staff is super courteous and genuine.”

    – Luci L.

  • “We love the team at Whitley dental clinic! Dr. Whitley was my son Jake’s (6) first experience with a dentist, now he looks forward to going back each time.”

    – The Cullen Family

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