Patient Forms

Welcome to the office of Dr. Robert Burks, where we proudly service patients in Winter Springs, Oviedo, Longwood and the surrounding Orlando, FL area. Dr. Burks and his team pride themselves on providing personalized treatment to each patient, and making them feel happy and comfortable every step of the way. Whether you’re interested in finding a caring family dentist or want to improve your smile with cosmetic dentistry, our office will go above and beyond to meet your needs.

Before coming into our Winter Springs office for your first visit, we ask that you complete the patient forms on this page. We also ask that you bring both your ID and dental insurance card, so that we can estimate the costs of your specific care. If you’re not sure about whether or not we accept your type of insurance, feel free to contact our office and one of our staff members would be happy to help you.

New Patient Forms

    Patient Registration
    Medical History
    HIPAA Acknowledgement of Receipt
    Notice of Privacy Practices
    Smile Assessment
    Sleep Health Questionnaire

    Emergency Patient Forms

    Patient Registration
    Medical History
    HIPAA Acknowledgement of Receipt   
    Notice of Privacy Practices

    What To Expect

    Dr. Burks will take the time to thoroughly review your past dental history and experiences before performing your initial exam and x-rays. Then, He'll use this information to diagnose any current issues and develop a plan of action for treating them. Our office strongly believes in open patient-doctor communication, and Dr. Burks will do his best to address all your questions and concerns. Please don’t hesitate to ask any questions you may have before, during or after the initial appointment!

    Your journey to a beautiful smile is a team effort, and together, we’ll provide you with healthy teeth that will last a lifetime!

    Contact Our Winter Springs Office To Get Started

    Thank you for choosing Dr. Burks as your dental provider! If you have any questions about our patient forms, treatment options or anything in general, please contact our Winter Springs office at (407) 327-2030 to speak to one of our staff members. We proudly provide treatment to patients of all ages in and around Oviedo, Longwood and Orlando. We look forward to meeting you and your family soon!