Phone number icon (903) 668-5477
Email icon
Address icon 303 S. Central Hallsville, Texas 75650


We understand that choosing the right dentist is important to you and your family. That’s why we have a safe, clean and comfortable environment.

We also offer the ability to download and print the New Patient Form if you would like to fill it out on paper. Click Here to download it.


Financially Responsible Party

Insurance Information

Dental History

Medical History


By clicking submit you agree that to the best of your knowledge, the above information is complete and correct. You understand that it is your responsibility to inform your doctor if you, or your minor child, ever have a change in health. You certify that you and/or your dependent(s) have insurance with the company listed (if listed) and assign directly to Hallsville Family Dentistry all insurance benefits, if any, otherwise payable to you for services rendered. You authorize the use of your signature on all insurance submissions. The above-named dentistry may use your health care information and may disclose such information to the above-named Insurance Company(ies) and their agents for the purpose of obtaining payment for services and determinig benefits or the benefits payable for related services. This consent will end when the current treatment plan is completed or one year from today's date. Payment is due in full at the time of treatment unless prior arrangements have been approved.