FORM 7: COVID-19 Screening Form

"A smile is a little thing that makes a big difference!"

FORM 2: Insurance Information

FORM 6: Health Information Consent Form

​FORM 4: Medical ​​Information Part 2

Note: There are a total of 7 forms to complete before you visit our office (unless otherwise directed).  

We look forward to seeing you soon!

FORM 5: Dental Information

If you self-pay you can skip this form and go to Form 3. 

Call Us:  315-548-5141

FORM 1: Patient Information

As of this week (8/5/21), we as a healthcare facility are required by the CDC to ask you these questions  prior to your appointment.

At entry all patients are required to wear a mask or face covering. We ask you to call us from your car for preauthorization and temperature check (per CDC guideline).

FORM 3: Medical Information Part 1

William S. Woodworth, D.D.S.

Do you have, or have you had any of the


Please share the following information with us. We will work together to insure you have a comfortable experience.