203-423-3833

Patient Forms

Going to the dentist can be an overwhelming experience, especially on your first dental visit. Let us put your concerns and anxieties to rest. Our goal at Fairfield Smiles is to make every patient experience as comfortable as possible.

To make your visit as pleasant and brief as possible, there are a few things you should bring with you. Please bring any dental X-rays from the last six months to your first appointment.

With just a few simple forms, we’ll ask for relevant medical history, any medications you might be taking, your dental history, and any dental insurance coverage you may have.

Want to get a head start? Download the new patient forms below.

These documents are in Adobe PDF format. If you’re unable to read PDF files, please download free Adobe Acrobat Reader here.

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Our Happy Patients

"I remember 10 years ago I was refereed to Fairfield Smiles after moving to the area, and I am so thankful for this because Dr. Cuevas and his staff are very friendly and caring people that do a wonderful job making my teeth/smile look amazing! Highly recommend."

Alana C.

"Dr. Cuevas and his team are terrific. Appointments are convenient and on time, the facilities and the staff are first rate and Erin the resident hygienist is simply the best. Highly recommended!"

Nevil E.

"I've been meaning to find a new dentist for quite some time and came across Fairfield smiles. I decided to give it a try and I had a great experience. The staff at the front desk were extremely friendly and helpful. Erin the hygienist was great. I didn't feel uncomfortable at all, and the overall experience was great. Definitely happy that I found a new place to go to from now on. Highly recommend!"

Danny M.
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