Dr. Lauren Anderson - Patient Registration - Wellness 2025

  • APPLY TO BE A PATIENT

  • All fields marked with * are required and must be filled.

  • Anderson Periodontal Wellness, Dr. Lauren Anderson, considers the heart of biological dentistry rooted in the concept that your mouth reflects your overall health. From the nutrients you consume to the way you breathe, every aspect of your well-being is intertwined. Our approach to oral health and whole-body health places focus on conservative, biocompatible, and advanced treatment methods.

    Complete this 3-part application to apply to be a patient at Anderson Periodontal Wellness.   The process includes:

    • Patient Health History & Questionnaire: Complete our short health history form and share with us your dental journey and goals.
    • Dental Imagery/Previous Records:
      • Using your smartphone, a friend, and good lighting, capture the requested images. (See the examples and descriptions provided.)
      • A copy of the most current panoramic and/or full mouth x-ray.
        (Available from your current dental office.)
    • Video: Record a video telling us why you would like to be a patient in our practice.

  • Basic Information

  • Date of Birth*
     - -
  • Format: (000) 000-0000.

  • Your Medical and Dental Information

  • All fields marked with * are required and must be filled.

  • Date of last dental visit*
     - -
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  • Does the esthetic of your current smile support the way you want to show up and feel in your world?*
  • Do you have amalgam (silver) fillings or metal crowns?*
  • Do you have root canals on any of your teeth?*
  • Did you have your wisdom teeth removed?*
  • Do you have any missing teeth?*
  • Do you have any implants?*
  • Have you ever had orthodontic (braces) treatment?*
  • Do you grind or clench your teeth?*
  • Do you have any clicking, popping, or discomfort in your jaw?*

  • Your Medical and Dental Information

    Continued

  • All fields marked with * are required and must be filled.

  • Are you currently working with any alternative healthcare providers (ie chiropractors, acupuncturists, naturopaths, functional medicine doctors, etc.)?*
  • Are you being treated for any chronic diseases?*
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  • Your Health Goals

  • All fields marked with * are required and must be filled.

  • Your Biological Dentistry Experience

  • Do you know that treatments offered by Biological Dentists are not covered by any insurance?*
  • Have you seen a Biological Dentist before?*

  • Your Dental Images

  • All fields marked with * are required and must be filled.

    1. FULL FACE - A full face shot with a natural smile
    2. NATURAL SMILE AT REST - A natural expression at rest
    3. BIG SMILE - A “cheesy” smile
    4. OPEN SMILE - A retracted smile, teeth slightly apart
    5. RETRACTED RIGHT SIDE - A retracted right side profile
    6. RETRACTED LEFT SIDE - A retracted left side profile
    7. UPPER ARCH - A retracted upper arch
    8. LOWER ARCH - A retracted lower arch
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  • When in doubt, capture the image further away than too close as the focus tends to blur when too close. All images should be taken with help for ease and quality.

  • We want to know a little more about you! Please upload a short video about why becoming a patient of Dr. Anderson is important to you.

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