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

Dentist in Randolph

Randolph Dentist | Preventing Enamel Erosion

Do you have white spots on your teeth? Are your teeth quite sensitive? Do your teeth have cracks, chips, or indentations? If yes, then you may be experiencing enamel erosion. Tooth enamel is the hardest substance in the human body. […]

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Dentist Randolph

Dentist Randolph | Oral Hygiene at Work

Do you brush your teeth after lunch? If you’re one of the millions of people who work outside the home, chances are you don’t have the time or resources to brush during the day. However, not being able to brush […]

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Randolph NE Dentist | Do I Really Need an Exam?

It’s highly likely that after visiting our Randolph dental practice, you understand the value of a thorough, professional dental cleaning. It’s also likely that you may not fully understand the importance of a complete exam and radiographs.  There are many […]

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