Patient forms at Galleria Dentistry
Fill Out Your Paperwork Before You Arrive, Not in Our Waiting Room
Complete your patient information, medical history, and consent forms
online before you come in, or print them and fill them in at home.
Either way, the minutes you would spend at the front desk go toward
your appointment instead.
The clipboard is the slowest part of a first appointment. Our patient forms are available online, so you can complete them on a phone, tablet, or computer and send them to us electronically. Paper works just as well. Print the forms at home, fill them in, and bring them with you, then plan to arrive about 15 minutes early so our front desk team can enter your information before we take you back.
Give the medical history questions a few extra minutes. Medications, past surgeries, and conditions such as hip or knee replacements affect what we recommend and how we treat you safely, and some cases call for a release from your physician or antibiotics taken before your visit. Bring a current list of your medications, a photo ID, and your insurance card if you have one. If a question on any form is unclear, call our Naples office ahead of time and we will walk through it with you.
- Complete every form from your phone, tablet, or computer
- Or print them, fill them in at home, and bring them with you
- Your health information is handled under our HIPAA privacy practices
Prefer Paper? Download and Print Your Forms
Here is every form we will need before your first appointment, ready to download, print, and fill in at home. Bring the finished pages to our Naples office along with a photo ID and your insurance card. If you would rather skip the printer, use the online option above and we will have your file started before you walk in.
Your contact details, address, employer, and dental insurance plan, plus the person responsible for payment. Seasonal residents can add a northern address and the months they are away.
Medications, allergies, past surgeries, joint replacements, and current conditions. What you list here shapes what we recommend and how we treat you safely, so take a few extra minutes with this one.
Payment is due in full at the time of service, and we accept cash, check, Visa, Mastercard, and American Express. The form also covers appointment cancellations and how we file insurance claims on your behalf.
How we use, store, and protect your health information, and the rights you hold over your own records. Review it, then sign the acknowledgement page so we can begin your care.
Coming to us from another dentist? This single page authorizes your previous office to send your x-rays to us, which can spare you a repeat set of images at your first visit.
Forms Done? Let's Get You Scheduled
Smile Gallery
Transformations We're Proud to Share
These before-and-after photos show real transformations from our Naples patients, including porcelain veneers, dental implants, and complete smile makeovers. At Galleria Dentistry, we combine artistry and proven techniques to restore confident, natural-looking smiles that feel as good as they look.
Full Mouth Reconstruction
Dental Crowns & Bridges
Porcelain Veneers
All-On-X Dental Implants
Meet your Doctors
Two Generations of Caring Naples Dentists
We believe every patient deserves to feel heard, informed, and confident in their care. Our doctors bring decades of combined experience along with a genuine commitment to treating you like family.
Practicing since 1982, Dr. Gery has perfected the smiles of multiple generations of Naples families. A Case Western Reserve University graduate, he’s been voted a Gulfshore Magazine Top Dentist every year since 2011. He treats every patient gently and takes time to give each one his full attention.
Born and raised in Naples, Dr. Anthony returned home to continue his father’s legacy after earning his DMD from Case Western Reserve University. An Eagle Scout with “Mentor” status in CEREC technology, he blends the technical and artistic sides of dentistry, and patients often comment on his caring chairside manner.
Dr. Chelsea earned her DMD from Case Western Reserve University, where she received honors from the International Congress of Oral Implantologists, and she is Past President of the Collier County Dental Association. She focuses on smile design and clear aligner orthodontics, and she explains each step so you know what to expect.
A second-generation dentist raised in Colombia, Dr. Adriana trained through USC’s Advanced Standing Program and graduated with honors in the Omicron Kappa Upsilon society. Inspired by her late father’s passion for dentistry, she chose our family-owned practice and honors his memory through the dedication she brings to every patient.
Become Our Next Success Story!
Experience personalized dental care designed to help you achieve your dream smile.
What Our Patients Say
Real Smiles From the Naples Families We Care For
Patients across Naples tell us they finally feel relaxed in the dental chair, confident in their smiles, and genuinely listened to. Their words capture the comfortable, honest care we work to deliver every single day.
Friendly, efficient, less than 3 minute wait.
Roanna Handy
1 day ago
All of the personnel are great! It seems like family. I will miss Dr. Gerry!
karen manson
3 days ago
Diane did a great job cleaning my teeth
Dawn Jakiela
5 days ago
Lisette is wonderful and very thorough.
M. E. Roche
1 week ago
What a great place. Professional and Gentle. Could have fallen asleep. Lisette is Definitely worth going too.
Scott Gregory
2 weeks ago
Diane does a great job
Richard Breithaupt
2 weeks ago
Your Story Could Be the Next One We Share
1982
Serving Naples Since
40+
Years Practicing Dentistry
98%
Satisfaction Rate
4.9
Average Rating
10,000+
Lives Changed
Come Visit Us
Your Neighborhood Dental Home in Naples
You’ll find us conveniently located in North Naples, easy to reach for families throughout the area and surrounding communities. At Galleria Dentistry, we’ve cared for generations of Naples neighbors since 1982, and we’re always ready to welcome you.
Ready for a smoother first visit
Your First Visit Feels Easier When Your Forms Are Ready Ahead of Time
- Electronic forms ready before arrival
- Medical history supports safer care
- Photo ID and insurance details prepared
