(571) 333-1250
Text: (571) 257-0225

Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

  • Patient Form (Dental)  PDF
  • Patient Form (Vision)   PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free. Still unable to open PDF files? We are more than happy to provide this paperwork to you!  We only ask that you arrive 20 minutes prior to your appointment with your insurance card and photo identification.

As a new patient, it is very important to disclose your complete medical history to our doctors. Please be as detailed as possible when completing your paperwork.

"It is always a pleasure to visit your office. Everyone remembers you and the personal touch means that you are not just a patient, you are a valued individual."

∼ Deborah M.

"Each experience with a wink & a smile is excellent. From scheduling to the wrap up after a procedure, everyone is highly professional, pleasant, knowledgeable, and helpful. Everyone takes the time to answer my questions thoughtfully and thoroughly. The clinical team is top notch as well, answering all my questions from the simple cleaning to more complex and anxiety-ridden procedures. Highly recommended!"

∼ Erica E.

"Our family has been patients at a wink & a smile for many years and every visit has been pleasurable and professional. The entire care team and front office staff are first rate with wonderful disposition and a genuine interest in your best health. Dr. Lee is a terrific dentist and does exemplary dental work when needed. This is a phenomenal practice for any family to join."

∼ Paul C.