(717) 259-9596 • East Berlin, PA
Forms
Make Your First Visit Simpler
You don’t have to spend extra time in the waiting room at your first visit. Instead, click on the patient forms below to access our forms. You can fill them out online and submit them, or you can view and print them to complete in your own time at home. Then when you arrive for your appointment, you’ll be all ready to go with all the important information we need.
Questions? Call our front desk at (717) 259-9596 and we’ll be happy to help!
PA Tongue-Tie Center Intake Form
PA TONGUE-TIE CENTER INFANT QUESTIONAIRE AND INFORMED CONSENT
PA Tongue Tie Center Toddler Questionaire and Informed Consent
EAST BERLIN SMILES NEW PATIENT EVALUATION FORM
Contact
East Berlin Smiles
Lori Cockley, DDS, MAGD
418 West King Street
East Berlin, PA 17316
Email Us
(717) 259-9596
Monday 7am - 7pm
Tuesday 7am - 7pm
Wednesday 7am - 7pm
Our Location
For door to door directions, click "View larger map."
Reviews
418 West King Street • East Berlin, PA 17316
(717) 259-9596
