Herndon, VA Dentist Office Patient Forms

The Herndon VA dentist office of Dr. Mark Jefferies welcomes new patients of all ages and makes every effort to make your visit as pleasant and efficient as possible. We have made it easy for you to complete some of that necessary paperwork in the comfort of your home before you visit with us. If you have questions, need assistance or prefer to complete forms in our office we are happy to accommodate you when you arrive. Please plan to arrive a few minutes early for your dental appointment or consultation if you need assistance or are a new patient visiting for the first time.

You can fill out your new patient forms online using our secure new forms portal:

Or, you can download and print your forms here.

Additional forms for specific dental health needs and concerns:

For Current Patients

Current patients can log in to their patient portal below: