Patient Registration

Online Dental Patient Forms

Save time in the office! Download patient forms using the links below. Print and fill out the forms completely as possible and bring them with you to your first appointment with Dr. D. Fritz or Dr. J. Fritz at Quad City Prosthodontic Specialists.

If you are not able to fill out the forms prior to your first visit, please plan to arrive 15–30 minutes early to complete the forms in-office.

• Health History
• HIPAA
• Patient Registration

For assistance, please call our office: Quad City Prosthodontic Specialists Bettendorf Office Phone Number 563-332-3691.

Office Hours

Technical Note

These forms are in PDF format. If you do not have Adobe Reader installed on your computer, you may download Acrobat Reader for free and use it to access these forms.