Maggie A. Kleem, DDS
352 West Bagley Rd
Berea, OH 44017
(440) 239-8389
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New Patients are always Welcome

Maggie A. Kleem Family Dentist Office always welcomes all new patients. For your convenience, our New Patient Forms are available below for reviewing and filling out at your leisure, saving you valuable time at your first appointment. Simply download, print, complete the forms and bring them with you on the day of your visit.

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post_extraction_instructions-1.pdf
File Size: 1403 kb
File Type: pdf
Download File

Post Extraction instructions 

New Patients:

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For your own convenience and in order to save you time and speed up your first visit experience - especially if you are a guardian of other family members, you can now download the needed forms at home, complete the forms and bring them into the office with you and we will get you started right away!
Simply follow steps 1,2,3 below
Be sure to bring ALL the completed forms with you for your first visit.


Patient registration
File Size: 448 kb
File Type: pdf
Download File

Medical History
File Size: 975 kb
File Type: pdf
Download File

1

New patient and Medical History forms (print and complete)


HiIPPA 1
File Size: 959 kb
File Type: pdf
Download File

HIPPA 2
File Size: 1050 kb
File Type: pdf
Download File

HIPPA notice
File Size: 963 kb
File Type: pdf
Download File


2


HIPPA forms (print, complete and sign forms)


Disclaimer
File Size: 679 kb
File Type: pdf
Download File

3

Disclaimer (Be sure to read completely)


* Please bring ALL the above forms at your first visit *
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