University Park Family Dentistry | Patient Forms and Information in South Bend

Back to main site


University Park Family Dentistry
Jeffrey A. Turner, DDS

16597 State Road 23

South Bend, IN  46635


Patient Forms and Information

Welcome to

University Park Family Dentistry, LLC

Dr. Jeffrey Turner

  • Photo Identification
  • Insurance Card (Dental and Medical) with booklet (if you have one)
  • Complete New Patient Forms by clicking on New Patient Forms, complete and submit
  • Previous dental records (if < 1 year since last dental visit)
  • Co-pay
  • List of current medications
  • A SMILE! J  


NEW PATIENTS:  If you can not make your scheduled appointment,

please contact our office with at least 48 hours notice,

failure to do so may result in future appointments being on "walk-in" basis ONLY.

Click on the form(s) you need to complete:


New Patient Forms

Existing Patient Health History Update


Address and/or Insurance Update




Contact Us

Please do not submit any Protected Health Information (PHI).