Download Forms

Preparing for Your Visit

Download and Print Our New Patient Forms

At Dr. Karl G. Espeleta, it is our goal to get you seated for your treatment in a timely and efficient manner. As with all medical offices, we do require paperwork to be completed prior to your visit. We provide the forms online so that you can thoroughly complete them in the comfort of your own home or office, where you can take your time and have access to all necessary information. Please download and complete the forms below to expedite your visit.

New Patient Forms

Dental Care

Additional Information

We also have information on the interactions of herbal medications and our shared parenting policy for minors. Please review the following documents if they pertain to you and your family. You can always contact us for more information
Dental Records

Records Transfer Request

Need a copy of your dental record? Please print and complete the following records release form and return it to our office. This form is required by our practice to verify that we have your permission to release your dental records.
Call us today to schedule an appointment.
937-836-6066
You can always rely on our dental care experts to provide you with individualized services. We pride ourselves on building great relationships with our clients. Contact us today to learn more about us and our services.
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