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Michael D. Couchot, D.M.D., M.D.
Diplomate, American Board of Oral & Maxillofacial Surgery
Diplomate, National Dental Board of Anesthesiology
Fellow, American Association of Oral & Maxillofacial Surgery

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Online Forms

For your convenience we've provided our patient forms for you to fill out at home before your appointment. Please remember to bring the forms with you to your first office visit.

> Patient Information Form
> Medical History Form
> Authorization to Release Health Care Information

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2844 Carter Avenue Ashland, KY 41101
(606) 329-1115
(606) 325-4639 Fax

Tri-State Oral and Facial Surgery, PSC., 2844 Carter Avenue, Ashland, KY 41101

(606)329-1115

Oral Surgeon Dr. Michael Couchot is board certified by the American Board of Oral and Maxillofacial Surgery and the National Dental Board of Anesthesiology. His special interests in oral surgery include dental implants, orthognathic surgery, dentoalveolar and trauma and facial reconstructive surgery involving bone graft reconstruction. Serving the Tri-State area (Ashland, KY, Ironton, OH, and Huntington WV) and Eastern Kentucky.