Patient Forms

To provide you with the most efficient new patient experience, please complete the forms below and bring them to your first appointment. Our team will take comprehensive records and address any concerns or questions you may have. If you have any problems completing the forms, please contact our office.

Visit Our Randolph Dental Office

Randolph Location

105 Broadway,
Randolph, NE 68771

(402) 337-0089

Bernecker

Our Dental News

Randolph NE Dentist | Filling in the Gaps: Your Options for Missing Teeth

Are you embarrassed to show your smile because of missing teeth? For many people, missing teeth can create a feeling of diminished self-confidence. Modern dentistry can not only replace the gaps in your smile, our team can also create long-term […]

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Randolph Dentist | 4 Tips for Healthy, White Teeth

Your smile is one of the first things that people notice about you. One way to make a lasting impression is to have a healthy-looking smile. Over the years, teeth whitening has become immensely popular. People turn to in-office whitening, […]

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Best Dentist Near Me | 3 Simple Ways to Reduce Tooth Decay

A happy smile is a healthy smile! There are a number of steps you can take to keep your smile healthy by reducing your risk of developing tooth decay. Here are a few suggestions from our team. Eat a Tooth […]

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