Patient Forms


Welcome new and returning patients! We’re glad you’ve chosen Smiles by Shields as your Jacksonville dentist and we’re honored to participate in your health and wellness. These forms are provided to help make your experience more pleasant with a shorter wait time when you visit our office.

* Please click on the form below. Fill out, print, and bring the form with you to your next office visit.

Dr. Shields Health History Form


New Patient Packet


X-ray Release Form