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Downloadable Patient Forms

Lansdowne Dental Care
“We change lives by creating beautiful, healthy smiles”

Award Winning Cosmetic Dentistry In Leesburg, VA

Find us at 19465 Deerfield Ave #406 Leesburg, VA 20176

Patient Forms & Resources

At Lansdowne Dental Care, our goal is not to just fix dental issues, but to prevent further ones from occurring. We are happy to treat every member of your family, and our philosophy is to treat our patients with the “end in mind”. Our practice utilizes high-tech diagnostic equipment such as digital x-rays, which are computerized x-rays that use less radiation as well as the Diagnodent laser which detects cavities. We recommend fluoride therapy, sealants, and nutritional counseling to prevent decay for both adults and children. Our hygienists are skilled in periodontal therapy and the use of medicinal adjuncts to treat periodontal disease.

**Once you have downloaded and completed the forms please email and attach forms to lansdownedentalcare@gmail.com

Download Your Forms

covid-19 Patient Consent Form

Medical History Form

Dental History Form

Confidential Information Form

Privacy Statement

Financial Options

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