(262) 377-0852

1200 Seventeenth Avenue
Grafton, WI 53024

Patient Forms

New Patients

Please complete your new patient paperwork prior to your first appointment. If you are unable to complete them online, we ask that you arrive for your appointment 15 minutes early and you may complete them here in the office.

Patient Paperwork Prior To Appointment

2013 HIPAA Notice of Privacy Practices

Please complete the forms below.

New Patient Registration & Medical History

Current Patients

Medical History updates are required every 3 years or when any medical changes occur. If you need to update your medical history Please complete the forms below.

Existing Patient Registration & Medical History

Office Hours

Office Location

Kurt R. Kwiatkowski, D.D.S. S.C.

1200 Seventeenth Avenue
Grafton, WI 53024
(262) 377-0852