Patient Information

Please click below to fill out the forms and bring it with you to your appointment:


New Patient Form Adult

New Patient Form Pediatric  

Existing Patients Forms Update

Notice of Privacy Practices (Print)

Dr. Pahouja and staff are dedicated to providing you with a pleasant visit and results that you’re proud to show off. Our administrative staff is ready to help you with questions about scheduling, financial policy and insurance, to make that part of the process as simple as possible.

Please print this page and bring it with you to your appointment


$150 Implant or Denture Consultation

Receive a consultation, and treatment planning for Implants or dentures.  Some restrictions may apply.  Valid for current and new patients. Valued at over $500. Cannot be combined with other offers.  No cash value. Expires 12/31/23


$269.00 – New Patient Dental Exam & Cleaning

Our new patient offer is a great way to become familiar with our office. We offer a professional Exam, X-Rays, and treatment planning for $269. Regular adult cleaning in absence of periodontal disease. Please call us and we’ll be happy to answer any questions you may have.  Valued at over $360.  Cannot be combined with other offers.  No cash value. Expires 12/31/23


$209.00 – New Children’s Exam, Cleaning, X-Rays and Fluoride special

New patients age 12 and under save over $100 on a professional dental cleaning, fluoride treatment, needed bitewing x-rays, and a doctor’s exam.  No cash value.  Not valid with dental insurance.  Cannot be combined with others.  Expires 12/31/23


teethWhiteningZoomZOOM Whitening Special 

SAVE $$ on your Zoom Whitening Special and get a FREE Sonicare Electric Toothbrush until 12/31/23. The ZOOM process enables you to lighten your teeth 5-8 shades in about an 90 minutes. You go home with your brighter, whiter smile. Call us at  Lifetime Smiles: Sunny Pahouja, DDS Phone Number 513-661-8586 to schedule your appointment. Compliance Seal