Lodo Dental

Brittany Seymour, DDS

Dental Information Center

Questionnaire

Welcome to Our Office

Please read the information below before proceeding:

Thank you for selecting us to provide dental care for you and your family. So that we may better serve you, please complete this questionnaire. Clicking the “Proceed” button below will deliver you to our secure server. The forms are protected with 128-bit encryption and all submitted information is confidential.

Submitting Information for Multiple Patients: If you are submitting information for more than one person, please fill out a unique form for every new patient. Once you complete each form, click the “Submit Another Patient’s Information” button to start a new patient form with the same address, billing, and insurance information.

We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via e-mail or other direct contact from you. We will not sell or rent this information to anyone.

We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request, e.g. to ship an order.

Unless you ask us not to, we may contact you via e-mail in the future to tell you about specials, new products or services, or changes to this privacy policy.

Brittany Seymour, DDS · 303-623-LODO (303-623-5636) · Member of the BBB

1435 Wazee Street · Suite 102
Denver, Colorado · 80202