Patient Forms

The following forms can be downloaded by simply clicking on the icon. Please download, fill out and bring the first two forms with you to your first appointment. The third form is for your personal records.

Patient registration form for patient to fill out prior to initial appointment.

This form is for new patient to keep.

Medical history form for patient to fill out prior to initial appointment.

Periodontal Associates of Chattanooga, P.A.

102 Walnut Street, Chattanooga, TN 37403

Office Phone: 423-756-2450

CHARLES B. FELTS, III, D.D.S., M.S.D.

Diplomate of American Board of Periodontology

Periodontics * Oral Medicine * Dental Implants

Instructions for day of surgery and information on prescriptions.