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Patient Forms

Patient FormsYou 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 each 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.

Tom E. Hartsock, D.M.D., M.S.

  • Tom E. Hartsock, D.M.D., M.S. - 161 College St., Suite 3, Pikeville, KY 41501 Phone: 606.432.3603

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