As part of our commitment to making your appointment at Smile Fixer RVA convenient and even relaxing, we have provided access to our patient forms on this page. You can print and complete your paperwork at your own pace and bring it with you when you come to see our dentist. Or, for even greater convenience, you can submit your forms to our office electronically. In addition to making your visit easier, it also gives our team time to learn more about your medical history and begin creating your personal treatment plan.

View Patient Form

View Online Patient Form

Our Mobile Apps
Our Patient Reach mobile app makes staying in touch with our office even easier. Our apps are available for iPhone and Android devices.




If you need assistance in completing your forms, or if you would like to plan your dental appointment in Richmond, Virginia, with Dr. Stacy Lukanuski, call 804-264-9460 and speak with a member our team.

Welcoming All New Smiles!

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