Capital Endodontics

(608) 442-3300

Monday – Friday 7:30am–4:30pm

Patient Forms

The following forms can be filled out and submitted electronically prior to your appointment or printed and submitted at the time of your appointment. If you would prefer to fill them out upon check in, please plan to arrive at least 15 minutes in advance of your appointment to complete forms.


INSTRUCTIONS: To submit forms electronically, please download and complete.
Then save forms and email to:


Adult Registration Form

Child Registration Form

The following forms are for your reference only:


Notice of Privacy Practices

Endodontic Post Treatment Instructions