Grapevine, Texas (TX), Dentists Jerry W. Burgess, D.D.S., and Scott A. Mason, D.D.S.

Patient Forms

Please help us be prepared for your first appointment by completing this Financial Information form. Download the form below (in either Word or PDF format) to your computer, print it out, complete the form, and bring it with you to your first appointment.

Financial Form [PDF format] >
Patient Information Form [PDF Format] >
Notice of Privacy Practice Acknowledgement Form [PDF format] >
Notice of Privacy Practices [PDF format] >

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Drs. Jerry Burgess and Scott Mason | 1105 West Wall Street | Grapevine, TX | Tel: 817-481-4717 | Fax: 817-488-8335

Burgess and Mason Family Dentistry provides quality dental care for children, teens, and adults in Grapevine, TX (Texas).
Dr. Jerry Burgess and Dr. Scott Mason specialize in general and cosmetic dentistry, offering teeth cleaning, teeth whitening and bleaching,
and obstructive sleep apnea treatments. Contact our practice to schedule an appointment.