7500 Iron Bar Lane, Suite 201
Gainesville, VA 20155

(Across the street from the Gainesville IHOP)

For your convenience, our patient forms are available online. We invite you to complete and electronically submit them before your appointment with our dentists in Gainesville, Virginia. This will make your visit more streamlined and efficient. We take your privacy seriously, and these forms are secure.

We will need X-rays for your first appointment with us and will take diagnostic photos that document what your teeth look like on the first day we see them. If your X-rays were taken within one year, please get in touch with your previous dental office to have electronic files sent to us securely. Unfortunately, without X-rays, the doctor cannot complete an exam, and your insurance will charge you additional fees to retake them. You must sign a release form that you can only get from them. Please note that we do not accept dental records via regular email. We treat your private dental health information like your physician’s office. We look forward to meeting you!

Feel free to contact Awesome Smiles Dental Center today for more information and to schedule a visit with Dr. Tontra Lowe, Dr. Emoke Basa, and Dr. Malik Lowe.

Click the links below to complete patient forms using a secure browsing session.

New Patients:

 

Existing Patients (Update Patient Forms for 2022):

 

COVID-19 SCREENING FORM:

  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
  • icon
Honoree