We are grateful that you have chosen us as your source for family-friendly, honest dental care. For our new patients, we ask that you download, print, and complete your new patient forms prior to your first visit with our dentists in Midvale, Utah. This will allow us to complete your paperwork faster and give you more time with Drs. Burt and Dimond.

We also invite you to review our Notice of Privacy Practices so you can be familiar with how our practice is run. You only need to read this form, but please print and complete the Acknowledgement of Receipt of Privacy Practices. If you have any questions about any of our patient forms at the dental practice of Chad S. Burt DMD & Kyle W. Dimond DDS, and to schedule your first appointment, please contact us today. We are happy to help in any way!

Online Forms

Online Forms

Download/ Print Forms

Patient Registration Form
Medical History Form
Consent for Services
Notice of Privacy Practices (Read this, but you don’t need to print this part.)
Acknowledgement of Receipt of Notice of Privacy Practices
(This is the part we need.)


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