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New Patients

Welcome to Jefferson Family Dentistry! We look forward to meeting you and exceeding your expectations.
Come in and see what all the fuss is about!
First Visit

For all new patients, we ask that you fill out some forms to help us gather important information about you.

For your convenience, these forms can be printed below, filled out and brought to your first appointment. If you take multiple medications, please bring a list.


You don't deserve to be in pain. We will do our absolute best to schedule you as soon as possible!  At your appointment we will evaluate the specific problem with a limited exam and any necessary x-rays. If treatment is indicated, we will do what is needed to make you comfortable. You may need to be rescheduled to complete additional treatment. Click here to learn more about our emergency services.


At your first appointment, we will complete a comprehensive evaluation which will include the following:

  • Review of Medical and Dental Histories

  • Head and Neck Exam

  • Oral Cancer Screening

  • Digital X-rays to evaluate the teeth and supporting bone

  • Periodontal Exam to evaluate the soft tissues (gums)

  • If treatment is indicated, a thorough explanation will be provided with x-rays and intra-oral photos, along with available treatment options

  • Time to visit with Dr. Van Beek and ask any questions

  • If treatment is indicated, an individualized Treatment Plan will be formulated with cost/insurance estimates and different treatment options (if applicable)

  • Dental Cleaning- You may or may not receive a dental cleaning at your first visit. If the evaluation is completed and time allows, a cleaning will be performed. In complex situations, the exam requires more time and explanation. If necessary, we will schedule you for another day to complete the cleaning

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