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WE ARE OPEN | Read our COVID-19 Protocols
Call Today203-349-3537 Request an Appointment
Call Today203-349-3537 Request an Appointment
111 Beach Road, 2nd Floor, Fairfield, CT 06824
  • Home
  • About Us
    • Meet the Doctor
      • Dr. Pablo Cuevas
    • Meet the Team
    • Why Choose Us
    • Tour the Office
    • Community Involvement
    • FAQ
  • Our Dental Services
    • General Dentistry
      • Dental Cleanings and Exams
      • Gum Disease Treatment
      • Mouthguards
    • Family Dentistry
    • Cosmetic Dentistry
      • Dental Veneers
      • Teeth Whitening
      • Smile Makeover
      • Tooth Bonding
      • Gum Reshaping/ Gummy Smile Treatment
      • Teeth Contouring/Crown Lengthening
    • Orthodontics
    • Restorative Dentistry
      • Tooth Fillings
      • Root Canals
      • Dental Crowns & Bridges
      • Dentures
    • Dental Implants
      • Same-Day Smile
    • Relieving Dental Anxiety
    • Dental Emergencies
    • Oral Surgery
    • TMJ Treatment/Teeth Grinding
    • Sleep Apnea
  • Patient Testimonials
    • Smile Gallery
  • Patient Resources
    • Specials and Promotions
    • Patient Forms
    • Payment Options
    • I’m Embarrassed To Smile
    • I’m Having Trouble Chewing
    • I’m In Pain Or Have Discomfort
  • COVID-19 Protocols
  • Blog
  • Search
Prepare For Your Visit To Our Fairfield Dentist Office
  • New patients can receive an exam for $97
  • Call for a free dental implants consultation
  • Relax in our comfortable heated chairs

Schedule An Appointment With Your New Dentist!

203-349-3537
Request an Appointment

We can see you as soon as tomorrow!

Home > Patient Resources > Patient Forms

Patient Forms

Below you will find Fairfield Smiles By Design’s new patient forms. These are the forms you will be required to fill out at your first visit to our office. To expedite the sign-in process and to help your first visit go more smoothly, please fill out the forms using the provided links before your appointment.

If you have any questions or need help filling out the forms, please contact our Fairfield, CT dentist office. A member of our staff will be glad to assist you. We can be reached by phone at 203-349-3537.

  • Notice of Privacy Form (HIPAA)
  • Fill Out Your New Patient Forms Online Here
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Call Today to Make an Appointment 203-349-3537 Request An Appointment
111 Beach Road, 2nd Floor, Fairfield, CT 06824
  • Mon: 8am-5pm
  • Tue: 8am-5pm
  • Wed: Closed
  • Thu: 8am-5pm
  • Fri: 8am-5pm
  • Sat: By Appointment
  • Sun: Closed
Call Today to make an Appointment 203-349-3537 Request An Appointment

Location

111 Beach Road, 2nd Floor, Fairfield, CT 06824

Office Hours

  • Monday 8am-5pm
  • Tuesday 8am-5pm
  • Wednesday Closed
  • Thursday 8am-5pm
  • Friday 8am-5pm
  • Saturday By Appointment
  • Sunday Closed

Latest Blog Articles

Teeth Implants Gave Bill a Great New Smile

Like many others before him, our patient Bill had a great experience with his teeth implants from Fairfield Smiles By ...

Read More
Professional Teeth Whitening Will Make Your Smile Merry and Bright

We wish you and yours a merry and bright holiday season! If you’re looking for a quick way to get a merry and bright ...

Read More
Call Today to make an Appointment 203-349-3537 Request An Appointment

Location

111 Beach Road, 2nd Floor, Fairfield, CT 06824

Office Hours

  • Monday 8am-5pm
  • Tuesday 8am-5pm
  • Wednesday Closed
  • Thursday 8am-5pm
  • Friday 8am-5pm
  • Saturday By Appointment
  • Sunday Closed

Latest Blog Articles

Teeth Implants Gave Bill a Great New Smile

Like many others before him, our patient Bill had a great experience with his teeth implants from Fairfield Smiles By ...

Read More
Professional Teeth Whitening Will Make Your Smile Merry and Bright

We wish you and yours a merry and bright holiday season! If you’re looking for a quick way to get a merry and bright ...

Read More
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