"General & Advanced Dentistry"

(409) 224-8197

From A Patient

"Appointments are on time. Office is very clean and organized. Everyone is helpful and pleasant. My dental hygienist is professional, efficient and gives friendly advice without scolding. I am a long time patient of Dr. Koch and appreciate the explanations and choices of services that he offers and he is as pain free as is possible with dental work."


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Texas Dental Association

American Dental Association

American Academy
of Implant Dentistry

Crown Council


Complete Your Patient Forms

Online, Print, or At Our Office

For your convenience, Family & Implant Dental Care offers three ways to complete your patient information.


Dental Office Jasper in Southeast Texas

Complete Your Patient Forms Online

We Offer A Few Ways to Complete Your Patient Information Form



We are pleased to offer you the convenience of completing and securely submitting your patient information online. Form can be completed from Smartphones, tablets, as well as computers.

    Securely Submit Patient Information Online

Download, Print and Bring In To Our Office

You can also print the Patient Information Forms, complete and bring them in when you arrive for your appointment. Requires the free Adobe Acrobat Reader.

    Download & Print Patient Information Forms

At our office

Of course, you can still complete your Patient Information Forms at our office. Please arrive at least 15 minutes early for your appointment, to allow time for you to complete the forms.



Sleep Forms

Sleep History Exam & Workup

Sleep Screening Consultation

Sleep Appliance Adjustment Follow-Up

Sleep Long Term Follow-Up



TMD Temporomandibular Joint Disorder Forms

TMD Screening Consultation

TMD Head, Neck Pain Exam & Workup



Other Forms

Oral Surgery & Implant Form

Periodontal Questionaire & Form

Orthodontic Questionaire & Form