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  • Jacobson Dental
  • Menu
  • Dental Services
    • Laser Treatment for Cold and Canker Sores
    • Cleaning and Prevention
      • Air Polishing
    • Cosmetic Dentistry
    • Tooth Fillings
    • Orthodontics
      • Invisalign
      • Metal Braces
    • TMJ
    • Teeth Whitening
      • Opalescence Go
    • Implants
    • Dentures/Partial Dentures
    • Crowns & Veneers
    • Root Canal Therapy
  • FAQ
  • Request An Appointment
    • New Patient Forms
  • Financial
  • Recent News
    • Dental Options for Missing Teeth
    • Escape the Pain of Sensitive Teeth
    • Social 6
    • Your Dentist and You: A Long-Term Relationship
    • Advantages of Dental Implants
    • Using Your Insurance Benefits
    • Better Denture Options
  • About Us
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New Patient Forms

New Patient Forms

For your convenience, we have our new patient forms available for downloading and preparing prior to your first appointment.  Our goal is to provide you the best, comprehensive dentistry services and having your dental and health information plays a key part of this process. We're looking forward to our first visit with you.

  • New Patient Questionnaire
  • Wisconsin Consent Form
  • Acknowledgement of Receipt of Notice of Privacy Practices
  • Dental Registration & History

 

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Time for a visit? Scheduling online is convenient. 

Schedule Appointment

Affiliations

  • DeltaDentalInsuranceLogo.gifDelta Dental Insurance
  • International Orthodontic Congress
  • ada_logo.gifAmerican Dental Association
  • wda_logo.gifWisconsin Dental Association
  • La Crosse Dental Association

Community involvement  

  • Business Booster Club Member
  • West Salem Business Association

Proudly Serving Patients From:

The greater La Crosse area, including Onalaska, Holmen, West Salem, and Sparta.

Hours

Monday – 8:00am to 6:00pm
Tuesday – 7:00am to 3:00pm
Wednesday – 8:00am to 2:00pm
Thursday – 8:00am to 5:00pm
Friday – 8:00am to 12:00pm

Contact Us

Jacobson Dental
1529 Heritage Blvd.
West Salem, WI 54669
USA

608-786-0900

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