Patient Forms

Registering as a DHA Patient

At DHA, we do all we can to make your appointments as convenient as possible. With Patient eForms you can complete your paperwork at home!

A fast, easy and secure way to fill out patient forms

Patient eForms is a secure, online registration that is simple, private, and a safe way for you to provide necessary pre-appointment information to Dental Health Associates before arriving at the office. You no longer need to arrive early to fill out paperwork before seeing your dentist. With the Patient eForms service, you can fill out all the necessary forms even weeks in advance of your appointment. This helps us get your information into the system and, most importantly, informs us of your insurance. Below you'll find a list of the DHA clinics. Please click on the clinic in which you are visiting and fill out the requested information.

Please click on a location and fill out the form:

Downtown Dental Office

44 E. Mifflin, Suite 204, Madison, WI 53703
608-256-0499

East Dental Office

East Endontic Office

East Perio Office

49 N. Walbridge Ave., Madison, WI 53714-3506
608-246-2555

South Dental Office

South Endodontic Office

South Perio Office

2971 Chapel Valley Road, Madison, WI 53711-7420
608-661-6400

University Dental Office

2713 Marshall Court, Madison, WI 53705
608-442-4400

West-Gammon Dental Office

West Endodontic Office

7001 Old Sauk Road, Madison, WI 53717-2308
608-833-2578

West-Old Sauk Dental Office

West-Perio Office

7017 Old Sauk Road, Madison, WI 53717-1010
608-833-1889

Why do you need my insurance information prior to my appointment?

This is extremely useful in advance as we can confirm coverage with your insurance carrier prior to your arrival on the day of your appointment.

What insurance information do I need to complete the insurance section?

As much information as you have is greatly appreciated. To get an accurate idea of your plan, though, the following information is needed:

  • your dental insurance name
  • the full name (as your insurance spells it) and date of birth of the subscriber (the person who holds the insurance)
  • the subscriber's employer the plan is through
  • your member ID number
  • the plan's group number
  • the insurance's phone number

All of this information is either located on your dental insurance card or in your packet of information sent to you by your insurance company after you enrolled in your plan. If you have questions, feel free to call us or bring your information to us, or call your insurance company to get direct answers.