Patient Forms

To make your dental experience quicker and more pleasant, Lifetime Dental Care provides our dental forms below, which you can fill out in the comfort of your own home and bring with you for your appointment with our dentist in Eau Claire, Wisconsin. Simply click on the form you need to download. For more information on our patient forms, please feel free to contact us. Dr. Anthony Butchert and our team look forward to meeting you!

Adult Registration Form

Child Registration Form

Dental Insurance Processing

Comprehensive TMJ Exam History Forms

Comprehensive Sleep Apnea Exam – Call for a link to a secure information portal.  

Financial Options
We are committed to providing you and your family with the highest possible level of care, and we strive to provide you with a dental experience that is comfortable and streamlined from start to finish. To help patients of Lifetime Dental Care reach their dental needs both physically and financially, we accept most dental insurances. Our goal is to maximize your insurance benefits and make any remaining balance easily affordable. If you have no dental benefits, we offer CareCredit and our own exclusive Dental Benefits Plan.

If expenses are preventing you from receiving quality dental care, we encourage you to contact our office today to discuss your financial options. We are happy to answer your questions and provide you with the information you need.

Special Offer!

Free Exam, Cavity Detection & 3-D x-ray*

*With insurance, new & returning patients:

Free exam, cavity detection X-rays, 3-D panoramic X-ray, and cleaning is included.

No insurance, new patients:

With paid cleaning ($93) exam, cavity detection X-rays, 3D panoramic X-ray are Free!






woman with beautiful smile