We want to make your stay with us as comfortable as possible. For your convenience, we have an online New Patient Questionnaire available for you to fill out before your appointment. Feel free to fill out the pages and print them if you want. When you fill out the form and submit it, everything will come to us via secure electronic connection. If you are unable to fill out the form prior to your appointment, please come 15 minutes early to your appointment.


Optional: Printable Version

If you have any issues with the online version of the questionnaire (above), you may fill out a printable version. Please click the button below, fill these out and e-mail the completed copy to us (step #5), or you can print and fill them out, neatly, prior to your first appointment. This helps us enter your information into your chart quickly.

Dental Patient Forms

There are a few ways you can get your forms to us:

  1. Fill out the forms in the Adobe® Reader software, sign it digitally, save the signed form and e-mail to ktdentist@aol.com.
  2. Fill out the forms in the software, print, sign and bring them completed to your appointment.
  3. Print, fill out the forms by hand and bring them completed to your appointment.
  4. Fill them out by hand and fax them to us at 281-579-1808
  5. Fill them out by hand, scan them in, and send them as a PDF to info@katyteeth.com
  6. Fill them out and mail them to:
    Harrison & Bethke Family & Cosmetic Dentistry
    attn: new patient forms
    21715 Kingsland Blvd., #105
    Katy, TX 77450

If you have any questions, feel free to call us at 281-492-6064. We're happy to help in any way, and look forward to seeing you soon!

More   Resources