3200 Old Jennings Rd.
Middleburg, FL 32068
3267 Hodges Blvd. #13
Jacksonville, FL 32224
To continue making your dental experience pleasant, we have conveniently provided our dental forms below so that you can fill them out in the comfort of your home and bring them into the office with you.
New Patient: Child
Children’s Medical History
Child’s Informed Consent
HIPAA/ Generalized Patient Consent
For New Patients Who Are Still Nursing
Frenectomy
Sleep and Speech
Sleep and Speech Questionnaire
New Patient: Adult
Adult Medical History (seen at our Middleburg office)
HIPAA/ Generalized Patient Consent
Records
Transfer of Records
Treatment
Treatment Deposit
Myers Pediatric Dentistry & Orthodontics would love to meet you and your family and provide you with the dental care you deserve! Our two offices are easily accessible to those living near Middleburg and Jacksonville to get the care they deserve.
Click here toRequest An Appointment OnlineOr call us today at: (904) 505-2010
