Dr. Charles Burnes and Dr. Camille Cassella
A Privately Owned Melbourne Family Dental Practice
17 Nelson Ave, Melbourne, Fl 32935
Call: (321) 259-2161

Patient Forms

The attached files contain our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out, emailing them, or bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Patient Forms (Print & Complete All Forms Prior To First Office Visit) 

Medical History

Business Policy

Patient Registration

HIPAA Policy

Important Information about your Estimate

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Testimonials

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Office Location

  • Melbourne
  • 17 Nelson Avenue
  • Melbourne, Florida
  • 32935
  • Map & Directions
  • Call: (321) 259-2161