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 Patient Forms

We Are Dedicated to Minimizing Your Wait Time

To save some time on the first appointment, please fill out our patient forms at home. Download and print our patient forms here. If you have any questions, please feel free to call our office at 1-765-473-9336. Thank you and we look forward to seeing you soon.



New Patient Forms:

  1. Download a New Patient Registration Form: Patient Info 2018 & Medication List 2018
  2. Download the Notice of Privacy Practices (HIPPA) Form


Maintain your Personal Information:

  1. Download a Business Card
  2. Download the Notice of Privacy Practices (HIPPA) Form
  3. Download and Update your Dental Insurance Information Form
  4. Download and Update your Personal & Medical Information Form



 Please Call Us!

We welcome you and your family to experience state-of-the-art dentistry, excellent clinical care, and superb customer service. Call our Peru Office at (765) 473-9336 if you have any other questions or would like to schedule an appointment. Our Peru Dental Office is conveniently located for patients across from Peru High School in Peru Indiana. We welcome the opportunity to give you a Smile-for-Life!


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Peru Indiana Dentist - Peru Dental Care - Dr. Thomas Guthrie - Dr. Justin Brown
5 Logan Street, Peru, IN 46970 - ph. (765) 473-9336

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