New Patient?

Save time at the office fill out the new patient form before you get there. Download,┬áprint, and fill out the forms then don’t forget to bring them with you when you come.

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Credit Card Monthly Payment Authorization Form

Sign up for convenient monthly payments processed through your credit card. Click on the button below to download the form then print it out, fill it out, and send it to our office. Please send your completed form to:

William B. Miller, DMD, PC
104 Old Mill Rd
LaGrange, GA 30240

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Medical History

Download and fill out your medical history in the comfort and privacy of your own home. Click on the button below to download the medical history form, print it out, fill it out, and bring it to the office with you.

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Can’t download or open the forms? You will need a PDF viewer like Adobe Reader. You can get Adobe Reader HERE

Adobe Reader