• (717) 267-1288
  • info@drakefamilydental.net
  • 4202 Philadelphia Ave, Chambersburg, PA 17202
  • (717) 267-1288
  • info@drakefamilydental.net
  • 4202 Philadelphia Ave, Chambersburg, PA 17202

Patient Forms

Doctor consulting with patient examining for patient

Patient Information Form

Fill Out and Submit
young-woman-at-the-dentist-LZGFZN9.jpg

Authorization for Release of Protected Health Information

Fill Out and Submit
dentist-doing-digital-xray-in-dentist-office-PEYMCLT.jpg

Patient Acknowledgement of Privacy Practices

Fill Out and Submit
small girl patient at the dentist

Child Information Form

Fill Out and Submit

Opening Hours:
Monday, Wednesday, Thursday: 8am – 5pm

Phone: (717) 267 – 1288
Email: info@drakefamilydental.net

Address: 4202 Philadelphia Ave, Chambersburg, PA 17202

Facebook-f

HIPAA Notice of Privacy Practices

Website Design by LaunchUX