Dental Patient Registration

New patients please print and bring the follow to your appointment:

1. Patient Registration Form

2. Medical History Form, and

3. Financial Policy Form.

The Notice of Private Practices Form is available for you to view only.

Fill Out Patient Registration Forms for Your Dental Visit

Good dental care is essential to maintaining healthy gums and teeth. Regular dental checkups will protect your teeth against dental issues and gum diseases. Get your teeth checked at our dental clinic located at 1448 N 2000 W #6 and walk out with a brighter, healthier smile. Schedule your appointment for a complete dental checkup. Call us at (801) 728-3924.

Registration Forms

At Bronson Dental, we offer complete dental care services and treatment. Please complete the following forms so that we can proceed with your appointment for your dental visit.

Print Patient Registration Form Print Medical History Form Print Financial Policy Form View Privacy Practices Form

Preferred Providers of the Following Insurance Companies

  • Aetna
  • Ameritas (with Connection Dental)
  • Cigna PPO
  • Delta Dental (Premier Only)
  • Dental Benefit Provider
  • Dentamax
  • DMBA
  • GEHA (with Connection Dental)
  • Guardian
  • MetLife (PDP Plus Only)
  • Regence Blue Cross / Blue Shied
  • TriCare / United Concordia

Schedule a Preventative Dental Checkup

Call us today!

(801) 728-3924

(801) 728-3924

Mission Statement of

Bronson Dental

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