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Available Forms

Check In - Mercy

Registration Information

Thank you for choosing UPD Dental Associates. We are so excited to see you today! Please fill out the below form to let our staff know you are here. Please stay in your car until we have called you at the number you list below.

Full name. If more than one patient, please list all patient names.
Full name.
We will call you at this number to let you know when we are ready.

We will call you at this number to let you know when we are ready for you to come in.

COVID Screening

Please enter the initial screening questions. During your intake, we will ask all present parties further about this, including taking all parties' temperatures. Please answer "Yes" if this pertains to any member of your party who will be coming into the office today.

* Required field