new patients New Patient Forms To make your first visit easier, please print and fill out the following forms to bring with you. Download New Patient Form Schedule a Consultation/Appointment Name(Required) First Last Email(Required) Phone(Required)Services Requested(Required) Preferred Appointment Time(Required) Mornings Afternoons Any additional information?Do you have your insurance information?Providing this information will speed up the check-in and billing processes. We can also ensure services requested are covered with your insurance. Yes No Insurance InformationEmployer associated with insurance company Subscriber Number Group Number Policy Number Date MM slash DD slash YYYY Patient Address Street Address City State / Province / Region ZIP / Postal Code CAPTCHA Lee’s Summit Family & Cosmetic Dental Care 4951 NE Goodview CirLee’s Summit, MO 64064 (816) 373-5574 Regular Business Hours Monday & Tuesday 7:30am-5:00pmWednesday 8:00am-5:30pmThursday 7:30am-4:30pmFridays Available by appointment For holiday hours, please check our facebook page for announcements. Follow us on social media!