Powell Dental Group
Shelley D. Shults, FNP, MSN, DDS, D.ABDSM
Emily Hutchins, DDS
Joseph E. Touhalisky, DDS

39 Clairedan Drive
Powell, Ohio 43065

Patient and Physician Referral Forms

For your convenience, New Patient Forms are available here for download for you to fill out and bring with you to your first appointment.

Dental Patient Forms

Adult New Patient Paperwork (Dental Patients Only)
Child New Patient Paperwork
Records Release Letter to Previous Dentist

New Dental Sleep Apnea Patients

Please complete the following prior to your appointment:

Sleep Apnea Dental Appliance New Patient Paperwork
Sleep Apnea Online Information (Secure, HIPAA Compliant Link)

Post-Op Care Instructions

Dental Post Op Instructions

Sleep Apnea Appliance Instructions

Care and Use of the Morning Repositioner
Care and Use of the Somnodent Sleep Apnea Appliance
Care and Use of the E.M.A.
Care and Use of Herbst Appliance

Physician Referral Forms

Sleep Apnea Physician Referral Form to Dr. Shelley Shults


The New Patient Forms are in Adobe PDF format. If you're unable to read PDF files, please download free Adobe Acrobat Reader here.

Have a Question? Ask the Doctor!