Patient Forms

To make your dental experience quicker and more pleasant, Lifetime Dental Care provides our dental forms below, which you can fill out in the comfort of your own home and bring with you for your appointment with our dentist in Eau Claire, Wisconsin. Simply click on the form you need to download. For more information on our patient forms, please feel free to contact us. Dr. Anthony Butchert and our team look forward to meeting you!

Adult Registration Form

Child Registration Form

Patient Health Questionnaire

Dental Insurance Processing

Sleep Health Questionnaire

Special Offers

With insurance, new & returning patients:
Included exam, cavity detection X-rays, 3D panoramic X-ray, and cleaning

No insurance, new patients:
With paid cleaning, included exam, cavity detection X-rays, 3D panoramic X-ray
Ask about our Dental Benefits Plan to save even more.
Contact us and ask for this special!
 

Financial Options

We are committed to providing you and your family with the highest possible level of care, and we strive to provide you with a dental experience that is comfortable and streamlined from start to finish. To help patients of Lifetime Dental Care reach their dental needs both physically and financially, we accept most dental insurances. Our goal is to maximize your insurance benefits and make any remaining balance easily affordable. If you have no dental benefits, we offer CareCredit and our own exclusive Dental Benefits Plan.

If expenses are preventing you from receiving quality dental care, we encourage you to contact our office today to discuss your financial options. We are happy to answer your questions and provide you with the information you need.