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(662) 429-5239

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Patient Forms

Our patient forms have been made available online for your convenience. Please feel free to download and fill out these forms at your leisure and bring them in with you for your first appointment.

Patient Information Form
New Patient Health History Forms
Insurance Policy
HIPAA Form
Cancellation Policy

Want to help a child in need?

Want to get a whiter, brighter smile?

You can do both! This March thru June, we will be
participating in our annual Smiles for Kids fundraiser. All the proceeds from our teeth whitening services will go directly to the Palmer Home for Children. Your payment will be a tax deductible donation to the Palmer Home. Please ask our team today about getting a whiter smile while helping children in need.

NPOO

NEW PATIENT SPECIAL!!

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Desoto Family Dental Care
460 Byhalia Road
Hernando, MS 38632
Call: (662) 429-5239
Fax: (662) 449-0758