(717) 259-9596 • East Berlin, PA

Forms

Make Your First Visit Simpler

You don’t have to spend extra time in the waiting room at your first visit. Instead, click on the patient forms below to access our forms. You can fill them out online and submit them, or you can view and print them to complete in your own time at home. Then when you arrive for your appointment, you’ll be all ready to go with all the important information we need.

Questions? Call our front desk at (717) 259-9596 and we’ll be happy to help!

PA Tongue-Tie Center Intake Form

PA TONGUE-TIE CENTER INFANT QUESTIONAIRE AND INFORMED CONSENT

PA Tongue Tie Center Toddler Questionaire and Informed Consent

EAST BERLIN SMILES NEW PATIENT EVALUATION FORM

Contact

East Berlin Smiles
Lori Cockley, DDS, MAGD
418 West King Street
East Berlin, PA 17316

Email Us

(717) 259-9596

Monday 7am - 7pm
Tuesday 7am - 7pm
Wednesday 7am - 7pm

Our Location

For door to door directions, click "View larger map."

Reviews

418 West King Street • East Berlin, PA 17316
(717) 259-9596