John Fasbinder, DDS
Call Us Today: (913) 341-6767
FELLOW, AMERICAN DENTAL SOCIETY OF ANESTHESIOLOGY
DIMPLOMATE, NATIONAL DENTAL BOARD OF ANESTHESIOLOGY
 
 

Forms

This section of our web site lists some of the most common forms that we use in our office. We have provided links to these forms in Adobe PDF format so you may view and print at your leisure. If you do not have Acrobat Reader you can download it free here. Please contact us with any questions you may have.

You can hand-carry filled out forms when you visit our our office
 

New Patient

This form is to be completed by all new Adult patients for their first visit, as it allows us to get to know you better.  If your first appointment is coming soon, please print and complete this form prior to your visit and bring it with you.  Also, please send any current dental x-rays to our office prior to your appointment.  You can have your dentist either mail them to: 3700 W. 83rd Street, Suite 109, Prairie Village, KS 66208 OR Email them to doctorfasbinder@gmail.com OR Fax them to 913-341-8077.

   

New Patient: Under 18 Years Old

This form is to be completed on behalf of all new patients under 18 years of age for their first visit. Please print and complete this form prior to their visit and bring it with you. Also, please send any current dental x-rays to our office prior to the appointment. You can have your dentist either mail them to: 3700 W. 83rd Street, Suite 109, Prairie Village, KS 66208 OR Email them to doctorfasbinder@gmail.com OR Fax them to 913-341-8077.

   

Records Request

If you have moved to a new location and would like us to send records to your new dentist, please contact our office at 913-341-6767 for the necessary medical release form.

   

Referring Doctor Information Sheet

   

Patient Instructions

This is a collection of forms that will provide detailed instructions for many of the procedures that we perform in our office. Please contact us if you need additional information, or you cannot find the procedure you want.
   
Crowns and Bridges Porcelain Veneers
Immediate Dentures Post Surgery Instructions
Info about Complete Dentures Restorative Materials
New Implant Prosthesis Temporary Crowns and Bridges
Occlusal Splints Tooth Colored Restorations
Partial Dentures Tooth Sealants
Physical Therapy for TMD