New Patient Registration Forms

We recognize that your time is valuable. We will make every attempt to see you at your scheduled appointment time. To save time, download our New Patient Registration Form. This may be easily completed using your keyboard and mouse. Print the completed form and fax it to us or bring it with you to your first appointment.

To print our New Patient Registration Form, please click on the link above. You will need Acrobat Reader, which is a free software program available by clicking the Get Adobe Reader button below.

Dr. Jim S. Caudill is a general, cosmetic and family dentist and he welcomes new patients from all over including Hazard, Whitesburg, Jenkins, Jackson, Hyden, Hindman, London, Harlan, Pikeville, Prestonsburg, Big Stone Gap, and Johnson City. Dr. Caudill provides dental services such as porcelain veneers, dental implants, full dentures, partial dentures, cosmetic bonding, porcelain fillings, porcelain bridges, crowns, root canal therapy, Lumineers, orthodontics, Invisalign, Zoom, teeth whitening, and digital x-rays as well as cleanings and preventive care.