Jacob C Lueder, DDS, MS, PLLC
Patient Forms

Contact Us!

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below. To schedule an appointment, go to our Appointment Request link above.

Office location:
Grand Rapids
2323 East Paris Ave. SE
Suite 102
Grand Rapids, MI
Phone: (616) 855-4070

This page allows you to download our most requested patient forms.  New patients should download and print the COMPLETE REGISTRATION PACKAGE below.

Please bring the completed forms with you to your initial visit.

    Or, completed forms can be faxed to:

        (616) 855-4170 (Grand Rapids Office)





 Consent Forms:

Consent for Dental Implants

Consent for Bone Regeneration

Consent for Conscious IV Sedation

Consent for Periodontal Plastic Surgery (Gum Graft)

Consent for Periodontal Surgery

Consent for Ridge Augmentation (Bone Graft)

Consent for Sinus Lift