"I would like to sincerely thank Dr David M Follis and his amazing staff at Select Dentistry. After several disappointed visits with previous dentists, my fear prevented me from getting the proper and much needed dental work. With extreme pushing by my husband, I reluctantly came to Select Dentistry. From the moment I walked through the door, I have been treated more like family than a patient….down to someone willing to hold my hand if needed. My fear is gone, thanks to your kindness and skills. I look forward to many years of smiling without pain!" Sincerely, Peggy Grams

Printable Forms Printable Documents

Printable FormsDental Registration & History Form



Printable FormsFinancial Policy Form



Printable FormsInformed Consent Form for General Dental Procedures



Printable FormsPrivacy Policy


Guardian Notice
A parent or guardian must accompany all patients under 18 at the consultation visit.
 

Your First Visit

Your initial appointment will consist of an examination, evaluation and a consultation explaining your diagnosis and treatment options. Occasionally, treatment can be done the same day as the consultation Normally, however, a second appointment will be required to begin your treatment plan.

Prior to your dental exam, you will need to provide information that will assist us in developing a dental care treatment plan for you. You need to fill out and sign the following forms:

Printable Forms
  • Dental Registration and History Form
  • Financial Policy Form - Please present your insurance information at this time. If you have medical or dental insurance, bring the necessary completed forms.
  • Informed Consent Form for General Dental Procedures

Any Medical Conditions?

It is extremely important that you alert us to any medical condition for which you are currently under the care of a doctor. Please let us know of any existing medical conditions that may be of concern prior to surgery (i.e. diabetes, high blood pressure, artificial heart valves and joints, rheumatic fever, etc.) or if you are on any medication (i.e. heart medications, aspirin, anticoagulant therapy, etc.) or require medication prior to dental cleanings (i.e. antibiotics, for pre-med).


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Member American Dental Association
LOCATION
1422 Lincoln Way East
South Bend, IN 46613
Tele: 574.232.8888
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OFFICE HOURS
Mon - Wed: 8 am - 5 pm
Thurs - Fri: by appt. only
8 am - 1 pm
Member Academy of General Dentistry