New Patient Forms

Please select the appropriate patient form below.

You’re Just One Step Away From the Smile of Your Dreams!

At the office of Dr. Ted M. Pinney, we take pride in each and every result we create. From complicated procedures to basic cleanings, we look forward to giving you quality, compassionate dental care. If you’re not yet a patient, please select the appropriate form below. We look forward to seeing you!

Dr. Ted M. Pinney
815 Marshall Road
Jacksonville, AR 72076

New Child Patient Form
New Adult Patient Form

“I went to a dentist for 25 years and I just recently switched dentists and I love the whole office. I like Dr. Pinney, I like his staff, and I would recommend him highly. He’s genuine.”

– Nell Polvado

We are open during the following hours:

Monday 8:00 a.m. – 4:00 p.m.
Tuesday 8:00 a.m. – 4:00 p.m.
Wednesday 8:00 a.m. – 4:00 p.m.
Thursday 8:00 a.m. – 4:00 p.m.
Friday Closed
Saturday Closed
Sunday Closed