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    • Home
    • Our team
    • Forms
    • Insurance
    • Contact Us
    • Gallery
    • Services
  • Home
  • Our team
  • Forms
  • Insurance
  • Contact Us
  • Gallery
  • Services

New Patient Form

To save time, download and fill out our patient forms and attach to the contact form below.

For any questions call 602-584-9740

Adult Health History (pdf)

Download

Child Health History (pdf)

Download

HIPPA & Financial Informed Consent (pdf)

Download

Adult Health History [Spanish] (pdf)

Download

Health History Update (pdf)

Download

Call 602-584-9740

Email us at- frontdesk@miragedentalcare.com

Have any questions or concerns? Send us a message or call us, and we'll get you on our schedule!


Fill out your patient forms to save time at your appointment!

Mirage Dental Care

13011 West Greenway Road Suite 104, El Mirage, Arizona 85335, United States

Hours

Open today

09:00 am – 05:00 pm

Monday - Thursday: 9am - 5pm

Friday - Closed

Saturday - Open one Saturday a Month (by appointment)

Sunday: Closed

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