eastin center for cosmetic dentistry

New Patient Questionnaire

Welcome to the Eastin Center for Modern Dentistry

Please read the below information 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.

dental information center

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Success Stories

After years of trying to get my dental problems solved, Dr. Eastin has been a godsend.

Curtis Eastin, DDS, ND
Center For Modern Dentistry
1250 Ironwood Drive
Coeur d'Alene, ID 83814
(208) 667-4844