Patient Forms

How to Prepare for Your First Dental Visit 

Your first visit to The Dental Anesthesia Center involves a few special steps so that we can get to know you. To understand what to expect, please read through this page. Here is what to expect at your initial appointment.

*Please complete all forms prior to your appointment*

*Please bring list of medications, including over the counter and vitamins *

*Please arrive 30 minutes prior to your scheduled appointment to complete your registration. Thank you!*

When you arrive, please bring your completed patient packet information, which can be found on links below.

We appreciate your help in having your paperwork completed. We look forward to meeting you!


Special Needs Patient Forms

Please print and fill out the following forms to bring to your dental visit:

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.


Adult Patient Forms

Please print and fill out the following forms to bring to your dental visit:

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.


Child Patient Forms

Please print and fill out the following forms to bring to your dental visit:

In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.


Are you a Patient or a Doctor that Needs a Record Release Form? Simply Click Below and Print.

Appointment Request
Call to Schedule 314-862-7844

Pictured above: Dr. Victoria Q. Daugherty consulting with patients.

Appointment Request
Call to Schedule 314-862-7844


Who Can Benefit From Sleep Dentistry and Sedation Dentistry?

Patients With:

  • Fear and Anxiety: Nearly half of people with dental problems avoid dental care because of their fears and anxiety. Modern, safe anesthesia techniques allow the fearful patient to have dental procedures accomplished with out the anxiety associated with dentistry.
  • Low Pain Threshold: People perceive pain differently. Some individuals have difficulty getting numb. With general anesthesia and sedation techniques, the perception of pain can be altered. Patients can be virtually pain free during treatment.
  • Sensitive Gag Reflex: Some patients may suffer from a severe gag reflex and are unable to have dental care completed with use of local anesthetic. Using anesthesia services can eliminate the problems caused by an active gag reflex.
  • Extensive Treatment: Completing dental treatment under general anesthesia can eliminate the need for multiple visits.

Patients Who Are:

  • Special Needs: Individuals with physical or mental disabilities can achieve complete dental care in a comfortable setting.  Sleep dentistry provides a safe and effective way for special need patients to receive the dental treatment they need. Patients will have a complete exam, full mouth series of x-rays (pictures of teeth), and a thorough cleaning while under general anesthesia.
  • Young Children: Children who are experiencing anxiety and are unable to cooperate for needed dental treatment can benefit from anesthesia services.
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