610 N. Miles St. • Elizabethtown, KY 42701 Ph: 270-763-6604 • Fax 270-763-6552 | E-Mail

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Save time on your first visit. Click on the links below, print out each form, fill them out and bring them with you on your first visit.

Derek P. Durbin, D.M.D.

Member of:
• American Dental
   Association
• Kentucky Dental
   Association
• Louisville Dental
   Association
• Fellow Intl. Congress
   of Oral Implantologist
• American Academy of Cosmetic Dentistry

Request an Appointment Today!

Office Hours:
Monday - Thursday
8AM to 5PM

Quality Care For:
• Dental Implants • Cosmetic Dentistry
• Family Dentistry

To prequalify for financing, please click on one of the logos below to go directly to their website & to fill out an application.

Adult - New Patient Registration: Word     PDF
Child - New Patient Registration: Word     PDF
Heath History Form: Word     PDF
Financial Policy: Word     PDF
HIPPA: Word     PDF