New Patient and Patient Forms

We would like to thank you for choosing us! We are committed to providing safe, gentle, state-of-the-art dental care. Dr. Kujak and his staff make every effort to ensure that you are comfortable and at ease every time you visit our practice. We are sensitive to your needs as a patient and you can always count on receiving individual attention. Our goal is to make sure your dental experience is a positive one!

What to Expect

On your first visit, we will listen carefully to your dental concerns and answer all of your questions. We will examine your teeth and gums and take any x-rays you may need. Then we will discuss the best course of treatment to meet your oral health and financial goals.

What to Bring to your First Visit:

  • Completed Patient Forms (download forms below)
  • Insurance Card
  • X-rays and records from your prior dental provider (if necessary)
downloadable New Patient Form - image
downloadable Health History image
downloadable Covid Consent image
downloadable Health History image
downloadable New Patient Form - image
downloadable Covid Consent image
Main Street Dental logo

1200 Main Street
La Crosse, WI 54601

PHONE: 608-784-4063
FAX: 608-782-5757
AFTER HOURS: 608-784-4063
EMAIL: CLICK HERE

HOURS

Monday: 8am - 6pm

Tuesday: 8am - 6pm

Wednesday: 8am - 5pm

Thursday: 8am - 5pm

Friday: 8am - 1pm

Weekends: Closed

Main Street Dental logo

1200 Main Street
La Crosse, WI 54601

PHONE: 608-784-4063
FAX: 608-782-5757
AFTER HOURS: 608-784-4063
EMAIL: CLICK HERE

HOURS

Monday: 8am - 6pm
Tuesday: 8am - 6pm
Wednesday: 8am - 5pm
Thursday: 8am - 5pm
Friday: 8am - 1pm
Weekends: Closed