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    • Diagnostic & Preventative
      • Dental Cleanings & Checkups
      • Digital X-rays
      • Fluoride Treatment & Dental Sealants
      • Oral Cancer Evaluations
    • Orthodontics
      • Braces
      • Invisalign®
      • Orthodontics FAQs
      • Orthodontics for Children
    • Periodontics
      • Gum Disease Treatment
      • Deep Cleaning
      • Scaling & Root Planing
    • Prosthodontics Dentistry
      • Implants
      • Crowns & Bridges
      • Partial & Full Dentures
    • Cosmetic Procedures
      • Whitening
      • Veneers
    • Restorative Dentistry
      • Crowns
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    • Oral Surgery
      • Extractions
      • TMD/TMJ Treatment
    • Endodontics
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PATIENT FORMS

Thank you for choosing
Sage Dental.

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We can’t wait to meet you!

To save time at your visit, we have provided forms below that you may print, fill out, and bring in with you to your appointment.
SAGE DENTAL New Patient Registration Form – English
SAGE DENTAL New Patient Registration Form – Spanish
These forms are in PDF format. You will need Adobe Acrobat Reader to view these. Click here to get Reader.

SageCare+ Discount Dental Plan

Don’t miss your chance to save up to 65% and keep
your smile healthy with your SageCare+ Membership

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Call us anytime at
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be happy to help.
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Enroll in SageCare+ at
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Disclaimers

Free Exam and X-rays Disclaimer and $100 Off Every $400 of General Treatment: 

*Fee-for-service patients only; cannot be redeemed with insurance plans, Medicare, Medicaid, TRICARE, discount dental plans, or combined with other discounts, treatment offers, or programs. Offer of Free dental exam, X-rays ($499 value, ADA codes D0150, D0210, D0330), and $100 off every $400 of General Treatment is non-transferable and valid at participating Sage Dental practices only for new patient appointments and for dental services performed by a general dentist. Minimum fee. Fees will vary depending upon required treatment. ADDITIONAL CHARGES MAY BE INCURRED FOR RELATED SERVICES WHICH MAY BE REQUIRED IN INDIVIDUAL CASES. Discount is not contingent on referring patients or purchase of additional services. Must mention offer(s) at the initial new patient appointment within 30 days of receipt of the offer(s) to redeem. Not valid for orthodontics or specialty treatments. Free Opalescence® Go Mini Whitening Kit ($45 value) offer cannot be redeemed by patients with insurance plans, Medicare, Medicaid, TRICARE, discount dental plans, or combined with other discounts, treatment offers, or programs. Offer is non-transferable, one per patient, while supplies last, only at participating Sage Dental practices, and upon completion of a new patient hygiene appointment. Valid for appointments completed within 30 days of receipt of offer to redeem. Must mention offer to redeem. Florida patients: THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT. Cindy Roark, DMD, General Dentist FL DN16590/Sage Dental Group of Florida, PLLC and GA DN013293/Sage Dental Group of Georgia, LLC, 6600 Congress Ave, Suite 150, Boca Raton, Florida 33487, (561) 999-9650.

**SageCare+ Discount Dental Plan is not dental insurance. Membership fees are non-refundable. Discounts shall not apply to any treatment started prior to enrollment or after membership expires. Discounts shall not apply to treatment paid in full or in part by an insurance policy. Fees may be changed at the discretion of Sage Dental at any time during the plan period. Discounts cannot be applied to insurance copayments or deductibles. Discounts cannot be combined with insurance benefits, other special offers or sales promotions advertised by Sage Dental, any third-party discounts, coupons, offers, or other dental discount plan benefits. Minimum fees only. Excludes all retail products. For Full Terms and Conditions, visit https://mysagedental.com/sagecare-terms-and-conditions/. All procedures are fees as performed by a Sage general dentistry provider. Fees do not include treatment performed by a specialty provider.

***ProClean Sonic Toothbrush and Opalescence Go Whitening Kit may not be suitable for all patients. Your doctor may recommend an alternative or suggest a minimum age of use. Free toothbrush upon initial enrollment only.

Orthodontics Consult Disclaimer:

Free Orthodontics Consultation ($175 value, ADA code D8660) available with an appointment at participating Sage Dental practices. Must mention offer(s) at the initial new patient appointment to redeem.  Cindy Roark, DMD, General Dentist FL DN16590/Sage Dental Group of Florida, PLLC and GA DN013293/Sage Dental Group of Georgia, LLC, 6600 Congress Ave, Suite 150, Boca Raton, Florida 33487, (561) 999-9650.

CareCreditTM Disclaimer:

Subject to credit approval. Minimum monthly payments are required. See https://www.carecredit.com/ for details.

Florida Residents:

THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE SERVICE, EXAMINATION, OR TREATMENT.

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