JC Family Dental
JC Family Dental

Patient Forms

New patient? Please download and fill out the following forms when you come in for your first appointment.

Patient Medical History Form

This form is mandatory for new patients. To expedite your visit, print this form, fill it out and bring it with you for your first visit.

New Patient Form
jcf np paperwork.pdf
Adobe Acrobat document [3.8 MB]

Privacy Notice

Please read over our Notice of Privacy Practices, acknowledging our privacy policy. There will be a copy available to you on your visit to our office.

Privacy Notice
JC Family Dental privacy notice.docx
Microsoft Word document [18.8 KB]
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Appointment Request

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What To Expect at Your First Appointment

Upon arrival we will provide you with our paperwork to fill out 15 minutes before your appointment(we can email the paperwork upon request). We will make all the necessary copies of your ID and insurance cards. Your dental insurance will be verified days prior to your appointment with the information you provide over the phone. Insurance verification is a complimentary service we provide so that you are never surprised by a bill! We call and inform you of any copays ahead of time. 

Once your paperwork is filled out, one of our fantastic assistants will bring you back and get you started. All of our assistants are xray certified and they will begin taking xrays. Why do we take xrays? There are many things that can be unseen to the naked eye. The xrays enable us to diagnose any decay( decay in between two teeth is very very difficult to detect without xrays), genetic abnormalities, bone loss, and much more. Xrays are a very crucial diagnostic service that must be done on your first visit. After your xrays Dr Chung will come in and do the complete examination and then either he or a staff member will clean your teeth. This is a great time for you to ask questions about your dental health. Dr. Chung will go through all of your medical and dental history with you and address and areas that are a concern. If you do have treatment that is diagnosed our skilled treatment coordinators will create a treatment plan for you based on the recomendations by Dr. Chung. The estimated prices are determined by the information we have already gathered from your dental insurance. We like to make sure you know as much about your treatment options as possible so we make sure any questions you have are answered.

We strive to make sure you have the best dental experience as possible!

Make an Appointment Today!

Call us at: (602) 375-8646


JC Family Dental

401 E Bell Rd

Suite #14

Phoenix, AZ 85022

Fax: (602)547-1301



Use our contact form to get in touch.

Office Hours

Monday        9:00-6:00

Tuesday       9:00-6:00

Wednesday  9:00-1:00

Thursday      9:00-6:00

Friday          Closed


Outside our regular business hours, please note our emergency care information.

Keep Your Teeth Healthy!

What is the best preventive care for your teeth? Find out how to make your next visit easier and more pleasant.

Get Social With Us

We are committed to continuously improving access to our goods and services by individuals with disabilities. If you are unable to use any aspect of this website because of a disability, please call (602) 375-8646 and we will provide you with prompt personalized assistance.

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