New Patients

Please note that we require 2 business days notice when canceling or changing dental appointments.

Patient Forms

New Patient Forms
New patients can fill out your information online or use the following pdf forms.
Patient Information Form #1
Patient Information Form #2

Medical History Form
You may fill out your medical history online or use our Medical History pdf form.

Dental History Form
You may fill out your dental history online or use our Dental History pdf form.

Financial Obligation
You may review and accept our financial obligation terms online, or  download our financial obligation form, sign it, and email it to us.

Privacy Practices
You may review and accept our privacy practices online, or download our privacy practices, sign it, and email it to us.

Contact Us




Location

Wurtzel Family Dentistry
4554 Washtenaw Ave.
Ann Arbor, MI 48108
Phone: 734-971-2675

Follow Us!