(352) 234-8535

New Patient
Registration Form

In order to provide our patients with a quick and enjoyable registration process, we’ve made our New Patient Registration Forms available to print and complete before arriving for your first appointment. The form links, including information on our Membership Savings Program, are available on this page.

When you arrive for your appointment at our office, you’ll be warmly greeted by our front office team. If you’ve printed and filled out your new patient forms ahead of your visit, bring them in so we can expedite your registration process. We will show you to a treatment room and take any necessary x-rays, after which you’ll meet Dr. Jackson for your personal consultation. He will want to know more about you, and what brought you into our Eustis office. If you have any questions or particular areas of concern, Dr. Jackson will welcome a discussion with you.

Once we have all the information we need from your comprehensive exam, we’ll talk about the findings with you and formulate a treatment plan that fits your needs. Depending on what will deliver the optimal final result, Dr. Jackson may combine cosmetic dentistry, restorative dentistry, or general dentistry treatments.

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Membership Savings Plan

More info, click here>>>  Membership Savings Plan

Jackson Dentistry is excited to offer our Membership Savings Plan for our patients without dental insurance.

Here are the BENEFITS of our plan:

  • No deductibles
  • No waiting periods
  • No annual maximums
  • No pre-existing condition exclusions
  • No claims to submit
  • No pre-authorization required
  • Discount on your other dental treatment
  • Establish vital, semi-annual preventive care visits to maintain optimal health

New Patient Registration

Click here to access New Patient Registration Form
 which you can either:

  • print, write on the form, and bring with you to your appointment.


  • open the file in Adobe Acrobat, type in the form fields, print, and bring with you to your appointment.

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Request an Appointment Online

At Jackson Dentistry, we want to make your visit as easy and painless as possible. To make the process even easier, you can now request an appointment online. When you fill out this form, we will follow up with you to confirm your appointment time as quickly as possible.

If you prefer to make an appointment by phone, please call us today at (352) 234-8535.