Topeka Dentistry
Carrie Peterson, DDS & Ben Rutherford, DDS

New Patient Forms

Save time waiting in our office by filling out necessary forms online. Feel free to give us a call if you have any questions.

Patient Registration Form

Health History Form

HIPAA Notice of Privacy Practices

Insurance Information

Have Questions? Get in Touch
If you have difficulty using our website, please email us or call us at (785) 266-9100
View the ADA Accessibility Statement