• Skip to main content
  • Skip to footer
Mid Bay Dental, PLLC
  • Request an Appointment
  • Home
  • Meet the Team
  • Advanced Dental Procedures
  • Cosmetic Dentistry
  • Dental Wellness
  • Contact Us
  • Home
  • Meet the Team
  • Advanced Dental Procedures
  • Cosmetic Dentistry
  • Dental Wellness
  • Contact Us

Request an Appointment

Cosmetic Dentistry
Cosmetic Dentistry

Request an Appointment

Please do not use this form if you have an urgent medical problem or you need to reschedule an existing appointment. Instead, contact our office at (850) 897-4200. After you submit your request, our appointment scheduler will respond within 48 hours. See below for forms to complete.

Patient Registration Forms

Mid Bay Dental in Niceville, Florida, welcomes you to our practice. Once you have made your initial appointment, you may preregister online by completing the interactive form(s) below, or you may download and print the form(s), fill them out, and bring them with you to your first visit. Completing the forms prior to your visit will help speed up the new patient registration process.

Also, be sure to bring any diagnostic films or other test results that may have been ordered or performed by another physician.

Downloadable Forms:

  • Dental History
  • Financial Policy
  • Health History
  • New Patient Registration
  • Notice of Privacy Practices Summary 
  • Sleep Survey

Please note:  It may take a few minutes to load the forms if you are using a slow internet connection. If you are unable to view the forms, you may need to download Adobe Acrobat for free by clicking on the icon below.

Footer

PATIENT
EDUCATION

Broaden your understanding of oral health, dental conditions, and the services we offer with our exclusive, A-Z patient education library.

Learn More

Testimonials

  • Kimberly C.

    Dr. Chase has mapped my mouth, fixed teeth, and provided caring and superior dental care for me and my family for years using top-of-the-line practices and equipment. She has been there in a pinch for me and really cares. I smile like a queen thanks to her!!

  • Michele G

    I had a great experience at Mid Bay Dental. Better yet, my 5-year-old daughter came home feeling very proud and happy after her dental cleaning. She was terrified of going to the dentist, and their staff made her feel extra special and gave her confidence about brushing and preventive care!

  • Adam F.

    The dentist and staff always take the time to explain everything to me, answer my questions, and give me the best direction for what I am trying to accomplish. The customer service at Mid Bay Dental is far beyond most other businesses.

  • Bobby R.

    Have been going to Mid Bay Dental for over 15 years, and they make us feel like family. Always willing to work with us on scheduling and welcome us on every visit. Highly recommend the staff here if you have any anxiety about dental visits. The office environment and staff make you feel calm, relaxed, and safe.

See More
  • Home
  • Meet the Team
  • Advanced Dental Procedures
  • Cosmetic Dentistry
  • Dental Wellness
  • Testimonials
  • Contact Us
  • Accessibility Statement
  • HIPAA Privacy Policy
  • Sitemap
Copyright © · Mid Bay Dental · All Rights Reserved

At Mid Bay Dental, Dr. Justine Chase and her staff offer patients in Niceville, FL, and Bluewater Bay area comprehensive dental care services including advanced dental procedures, dental wellness, and family and cosmetic dentistry.

iHealthspot Medical Website Design and Medical Marketing by iHealthSpot.com