• Diplomate, American Board of Endodontics
    D.M.D., M.S., P.C.
    105 Parker Dr LaGrange, GA 30240

Patient Registration Forms

Before visiting our office for the first time, please download, print and fill out both of these forms.  They are in Adobe Reader format.

  1. Patient Registration Forms– A form that includes your medical history and other vital information needed to provide you with the highest level of care.
  2. Consent to Endodontic Therapy  – A form to let patients know about the various procedures involved in endodontic therapy and to obtain their consent before starting treatment.
  3. Privacy Notice – A form that details how your health information may be used or disclosed and how you can get access to that information.
  4. Doctor’s Referral Page and Form – Please note the referrals page is for use by the dental professional only.

Make An Appointment

Make an appointment with Dr. Fagundes at our LaGrange office where we proudly serve the surrounding areas of Greater West Georgia.