Medical History

Please bring with you a copy of your dental insurance card, drivers license, medication list, and any x-rays that have been taken within the past two years by your previous dentist. X-rays can be sent via email to: canton@utterbackdental.com or alliance@utterbackdental.com.

Prior to your first appointment at our office, we ask that you please complete the following secure online forms regarding your medical history as well as any dental issues that may help us prepare for your first visit.

For patients going to the Canton office at the 2414 Whipple Avenue location, please use the following link:

Canton Form

For patients going to the Alliance office at the 1360 South Sawburg location, please use the following link:

Alliance Form

Contact Us

What People Are Saying

View All Testimonials

Improve and maintain your healthy smile. View Our Services