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Phone: 281-859-9073
Houston, TX

Patient Registration

Forms for New Patients


Click HERE to fill out and SUBMIT ONLINE.

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The forms listed may be downloaded and completed prior to your appointment.  This will save you time at your first visit.

If you will be using dental insurance, please submit all information at least 24 hours before your scheduled appointment to allow us adequate time to obtain all benefit information.

Click HERE to print forms, fill them out and bring them to your appointment or fax them to us at 281-859-0211.


Click HERE to UPDATE existing patient information and submit ONLINE

Children under the age of 18, must be accompanied by a parent or legal guardian to ALL DENTAL APPOINTMENTS.

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Innovative Smiles

The office of Jerry L Wender DDS, PA & Ali Alkhiro DDS
8955 Hwy 6 N #200
Houston, TX 77095
Tel: 281-859-9073

Our Office, is dedicated to providing you with a pleasant visit and results that you're proud to show off. Call 281-859-9073 with any questions or to make an appointment.

Proudly serving Houston and surrounding communities including:

  • Cypress TX
  • Katy TX
  • Copperfield Place TX
  • Jersey Village TX
  • North Houston TX
  • Cinco Ranch TX
  • Mission Bend TX
  • Sugarland TX