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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 download, print, and fill out the forms before your appointment.

New Patient Forms

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.

 

What Our Patients are Saying

B. P. (Verified Patient) | Dec 25, 2019
5
Outstanding experience, as always.

Outstanding experience, as always.

L. K. (Verified Patient) | Dec 09, 2019
5
Excellent new equipment and a clear explanation of my dental concerns

Excellent new equipment and a clear explanation of my dental concerns

M. R. (Verified Patient) | Nov 12, 2019
5
Very friendly and thorough.

Very friendly and thorough.

A. R. (Verified Patient) | Oct 17, 2019
5
Dr. Cuevas is truly an exceptionally talented and compassionate gentleman. My smile is now beautiful...
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Dr. Cuevas is truly an exceptionally talented and compassionate gentleman. My smile is now beautiful again! And a shout out to some of his outstanding talented staff of professionals, including Remi, Erin and May!

M. T. (Verified Patient) | Oct 15, 2019
5
Staff friendly & knowledgable. Always get competent service from Dr Cuevas and Erin , my...
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Staff friendly & knowledgable. Always get competent service from Dr Cuevas and Erin , my hygenist!! And they adhere to scheduled appointments..

B. C. (Verified Patient) | Jul 26, 2019
5
You will tell I was really impressed today when I went to Dr Cuevas’s office...
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You will tell I was really impressed today when I went to Dr Cuevas’s office for a “regular” teeth cleaning. Things were going exceedingly well ( as Erin complimented me on my improved daily cleaning results ), when her mood changed suddenly. She had discovered and measured a pocket void on two sides of a molar which decades ago had had a root canal. She immediately worried it could be indicating a cracked tooth, but only Dr Cuevas’s expertise and maybe an X-ray would tell us more. I had no pain or irritation of any kind and I had a similar cracked tooth many years earlier which was not discovered until I had experienced much discomfort due to infection. So I was completely surprised. Erin’s preliminary diagnosis proved to be right on the button, proving what I had sensed over a few years of her cleanings...that she is really well schooled and trained in what she does so well ( a true studied and academic scientist), with the experience to readily identify a problem which very well could turn into a painful emergency down the road. By the way, the X-ray machine was brand new and state of the art not requiring me to jam into my small mouth an number of small X-ray plates. It just revolved around my head as I stood in place. I made my appointment for the extraction with Dr Cuevas but was told, if I would like to wait an hour it could be accomplished this afternoon, so I did not have to trek back, and it was. Once again, no pain no matter how hard this 60 year old tooth was to get out. What a pleasure to eliminate the problem before it was a painful emergency in a state of the art dental operation with really well trained professional staff. David C. Wilton CT

R. G. (Verified Patient) | May 03, 2019
5
(Translated by Google) Meeting Dr. Cuevas is the best thing that could happen to me....
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(Translated by Google) Meeting Dr. Cuevas is the best thing that could happen to me. After many years looking for a good dentist without success, the fear of so many visits full of bad times and a lot of pain, made me avoid them completely; Until a good day by recommendation of acquaintances I went to his office ... what a nice difference! He is a professional who gives a warm and respectful treatment to his patients. Your office is equipped with the latest technologies, is well located and with enough parking, its employees are efficient and friendly, always trying to make me feel good. I recommend Dr. Pablo Cuevas without reservation and with great pleasure. Oh, I forgot an important detail, Dr. Cuevas speaks Spanish and is always in a good mood. (Original) Conocer al Dr. Cuevas es lo mejor que me pudo pasar. Despúes de muchos años buscando un buen dentista sin exito, el miedo a tantas visitas llenas de malos ratos y mucho dolor, me hizo evitarlos por completo; Hasta que un buen dia por recomendacion de conocidos fui a su consultorio... que agradable diferencia! Él es todo un profesional que le da un trato calido y respetuoso a sus pacientes. Su oficina esta equipada con las últimas tecnologías, esta bien situada y con suficiente estacionamiento, sus empleadas son eficientes y amigables, siempre tratando de hacerme sentir bien. Recomiendo al Dr. Pablo Cuevas sin reservación y con muchisimo gusto. Ah, se me olvidaba un detalle importante, El Dr. Cuevas habla español y siempre esta de buen humor.

K. W. (Verified Patient) | May 03, 2019
5
Fantastic Practice! The staff makes every visit comfortable in a professional and friendly environment!

Fantastic Practice! The staff makes every visit comfortable in a professional and friendly environment!

J. G. (Verified Patient) | Apr 30, 2019
5
An excellent experience all-around. Dr.Cuevas, Erin and the rest of the staff are extremely knowledgeable,...
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An excellent experience all-around. Dr.Cuevas, Erin and the rest of the staff are extremely knowledgeable, patient, helpful and awesome at what they do. They were able to fix a few minor issues I was dealing with, and I already felt significantly better the day following my appointment. They will help you with your immediate issues as well as developing a long-term plan of care for your dental health. Highly recommend if you're looking for top-notch service in our area (bonus, they accept most major insurances!) Looking forward to working with them on an ongoing basis!

S. F. (Verified Patient) | Apr 30, 2019
5
Always a great experience! Chose this office for my dental implants (4) and could not...
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Always a great experience! Chose this office for my dental implants (4) and could not be happier! Thank you again for giving me back my smile!

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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