Accessible Version
LRK Dental
Janette Rodriguez DMD, John C. Lynch DDS, Michael Keller DMD

New Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

Acknowledgement of Receipt of Notice of Privacy Practices

Notice of Privacy Practices

Language Assistance

HIPPA Consent Form

Financial Responsibiltiy Policy

Health History for Child Patients

Health History for Teen Patients

Health History for Adult Patients

OCR Notice of Non-Discrimination

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (302) 629-7115
View the ADA Accessibility Statement