Patient Forms

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Online Forms

You may access the following forms to assist us with your care. Please complete the following forms and click the submit button at the bottom of the form:

*We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPAA compliant.

Printable Forms

For your convenience, you may download and print the following form and bring it to your next appointment:

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*This form requires Adobe Acrobat Reader. Click the Adobe logo above to download.

Brian Kerr D.M.D., P.C.

  • Dunmore - 402 N. Blakely St., Dunmore, PA 18512 Phone: 570-344-0605 Fax: 570-343-0113
  • Montrose - 24 Public Ave., Montrose, PA 18801 Phone: 570-278-1227 Fax: 570-343-0113
  • Tunkhannock - 158 W. Tioga St., Tunkhannock, PA 18657 Phone: 570-836-6210 Fax: 570-343-0113

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