Patient Forms

Welcome to our practice!

At Lawson Family Dental, we want to make your visit as easy and convenient as possible. With new protocols in place to help contain the COVID-19 pandemic, we have implemented online forms for all of our patients to be completed before their visit. During your visit we will be limiting as much paper handling and in-person contact as possible to ensure your health safety.

Please fill in your information before you visit our office; if you have any questions please call 515-278-4366. Thank you for your cooperation!


  • Patient Information & Dental History
  • Medical History Form
  • Alternate Communication Form
  • Registration Form
  • HIPAA, Financial Agreement, Signature & Consent


  • Medical History Form
  • Registration Form
  • HIPAA, Financial Agreement, Signature & Consent
  • Healthy Start Patient Form

  • Sleep Disordered Breathing Questionnaire for Children

    The initial column should be filled out at first appointment. Please identify the following symptoms your child exhibits with the scale indicating severity of symptoms.

    Not Present: 0
    Mild: 1-2
    Moderate: 3
    Pronounced: 4-5
  • Does your child:

  • (If yes, fill out speech questionnaire below)
  • Speech Questionnaire

    To be filled out only if #27 was indicated above
  • Please check all that apply to your child

COVID-19 Update

Dear Patients,

Based on guidelines from the Iowa Dental Association (IDA) and to help curtail the spread of COVID-19 (Coronavirus), our office will be closed for non-essential treatment until May 18th, 2020.

We will still be available for emergency and necessary treatments for our patients. Please call 515-278-4366 to speak with a team member.

Dr. Lawson will also be providing complimentary online consultations during this time for the following treatments:

  • Cosmetic Dental Work
  • Sleep Apnea (Children & Adults)
  • Orthodontic Work
  • Future Dental Treatments

We are following all guidelines and recommendations brought forward by the IDA. We thank you for your support and look forward to getting through this crisis safely.

Dr. Jessica Lawson and Lawson Family Dentistry