Patient Forms

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 arrive for your appointment.

Please complete our new patient paperwork at least 48 hours before your scheduled appointment. If you have had digital radiographs taken within one year that you would like us to have, we request that they be emailed to our office in advance to

Current patients can now utilize our patient portal set up for checking appointments and updating forms.

Contact us

Smiles by Shields
3940 San Jose Park Dr.
Jacksonville, FL 32217