Skip to content
Surprise Family Dentistry

Patient Portal

Your forms, appointments, and statements — all in one calm place.

That code didn't match. Please check and try again.

Your access code is included with your appointment reminder.

Demo portal — try access code surprisedental2026. This is a sample dashboard, not real patient data.

Secure patient area · Surprise Family Dentistry

Surprise Family Dentistry Patient Portal
Back to site

Patient dashboard

Welcome back, Jordan

Here's everything for your upcoming visit — finish your new-patient forms, review your appointment, and take care of any open statements.

2
Forms to finish
1
Upcoming visit
$95
Balance due

New-patient forms

Complete these before your visit to save time at the front desk.

Patient registration
Contact info, insurance, and emergency contact.
Completed
Health history
Medications, allergies, and medical background.
Start
Consent & privacy (HIPAA)
Review and sign our privacy and treatment consent.
Review & sign

Appointments

Your next visit and recent history.

Tue, Jul 14 · 9:30 AM
New-patient exam & cleaning · with Dr. Reyes
Reschedule Add a note
  • Jan 9, 2026 · 10:00 AMCleaning & exam · completed
  • Jul 11, 2025 · 2:15 PMFilling (#19) · completed
  • Jan 3, 2025 · 9:00 AMCleaning & exam · completed

Statements & billing

Pay open statements securely online.

StatementDateDescriptionAmountStatusPay

Payments here are simulated for this demo — no real charge is made.

Message the office

Have a question about your visit, insurance, or a form? Send a note and the front desk will follow up.

Or call us at (480) 555-0100.

© Surprise Family Dentistry · Patient Portal (demo) · Site by Incline Digital Marketing Agency