Challgren Dentistry

New Patient Forms

Save time waiting in our office by filling out your new patient form before your first visit. Download a printable PDF form by clicking on the links below.  Adult forms are for individuals 13 and over. Child forms are for those 12 and under. Feel free to give us a call if you have any questions.

Our HIPAA privacy policy is also available for you to review.

New Patient Adult

New Patient Child

HIPAA Privacy Notices

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (765) 446-9606
View the ADA Accessibility Statement
Our office has implemented several new procedures in order to provide a safe environment for our patients and staff during the COVID-19 pandemic.  Our waiting room is currently open for patients with an appointment and for parents of children during their appointment.  Masks are currently recommended but not required in our waiting room.  We do ask that you please practice social distancing whenever possible in the office.  As a patient you will be asked a series of covid-19 screening questions after being brought back to the treatment room.  We have implemented many new cleaning and disinfecting measures throughout the office.  Air purifiers have been installed in each procedure room.  Please know that we are continually monitoring the pandemic and are dedicated to keeping our patients and staff as safe as possible. We appreciate your patience and understanding during this time.