Online Patient Registration
Patient Registration General Health History Dental Health History

We are delighted to welcome you into our dental practice and are pleased that you have chosen us to provide you with superb dental care. We are committed to providing you with quality dental care at reasonable prices and proud of our dedication to our patients.

Please take a moment to complete your Patient Registration Forms, filling in all requested information, including the names of any medication prescribed to you. Rest assured that we take your privacy very seriously, and can assure you that our site is 128 bit encrypted for your security.

Plan to arrive 15 minutes prior to your scheduled appointment time. You will be asked to review, and sign your forms. We will ask for your drivers license, and insurance cards (if applicable) at that time for identification purposes. Please remember to bring any x-rays you may have from your previous dentist. We will also take your picture for your chart.

If your appointment is for your new patient examination, please remember that it may not include a cleaning at this appointment. This would depend on several factors that will be discussed with you at your visit.

For your information, we do not accept personal checks. We do accept cash, VISA, Mastercard, Discover as well as American Express debit or credit cards.

If you have any questions, please contact us at 302-DR-TEETH (378-3384) or email us at

We look forward to welcoming you into our dental family.


Dr. Jeena Jolly and Staff at Jolly Smiles

© 2009 JS Online Patient Registration. All Rights Reserved.
Home Contact Us