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  • About Us
    • Our Team
    • Our Office
    • Our Technology
  • Services
  • Financial
  • FAQs
  • Contact Us

Patient Forms

To help you prepare for your visit at Arlington Dentistry, we have provided our patient forms online. Simply complete these forms before your appointment in order to save some time when you visit us. If you have any questions about our forms or your first visit with our dentist, Dr. Withrow, we invite you to call us at your convenience. We look forward to taking care of you!

New Patient Questionnaire

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Health Insurance Portability and Accountability Act of 1996

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Disclosure and Access to Medical Information

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Authorization for Release of Identifying Health Information

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Consent for Services

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Resources

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Services

Exams & Hygiene
Crowns & Bridges
Cosmetic Dentistry
Endontics
Periodontics
Implant Dentistry
Botox & Fillers
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Location

119 Arlington Drive
Madison, AL 35758
(256) 461-4184

Business Hours

Mon-Fri: 8:30 – 5:00

If you are having difficulty using our website, please call us at (256) 461-4184.

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