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Walker Square Dental Associates
B. James Rogge, DDS
Creating Healthy, Beautiful Dover Smiles

Patient Forms

Patient Forms - Dover Dental Office of B. James Rogge, DDS 

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  

Included in these new patient forms are:

  • Patient Information and Health History (2 pages)
  • Office Appointment Policy (1 page)
  • Notice of Privacy Practices (2 pages)
  • Acknowledgement of Receipt of Notice of Privacy Practices (1 page)

(Click below to download.)

FORMS FOR NEW PATIENTS OF B JAMES ROGGE, DDS

Thank you, and please call our office if you have any questions at all.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
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Office Location

  • Dover
  • 838 Walker Square
  • Suite 21-1
  • Dover, DE
  • 19904
  • Map & Directions
  • Call: 302-736-1423