Jodi Burth, D.D.S.

6364 Main Street

North Branch, MN 55056

651.674.8128

New Patients

 

Welcome to our office!

 

For each new patient, please fill out, print and bring the following forms with you to your first appointment.

 

We can also mail forms to you if you'd prefer. Please call our office to make arrangements.

 

If you are unable to do so, please arrive 15 minutes prior to your appointment to fill out the necessary paperwork.

 

 

 

Forms

Patient Information Form

 

Dental History Form

 

Medical History Form

 

 

The following form is optional to print and is for your reference only.

 

Updated Notice of Privacy Practices

 

Updated Notice of Privacy Practices (en español)

 

 

Thank you. We look forward to meeting you and welcoming you into our dental family.

 

 

RECENT NEWS & EVENTS

Check Back

 

Check back for recent news and events from our office

CONTACT

6364 Main Street

North Branch, MN 55056

(P) 651.674.8128

(F) 651.277.9144

Clear Creek Dental Proudly Serves the Following Areas around North Branch, MN:

North Branch, Harris, Stacy, Cambridge, Pine City, Rush City, Isanti, Forest Lake, Lindstrom, and Chisago City