When you are a new patient with our office, we will ask you to fill out various forms. Please download the forms below, fill out before your reserved appointment time and bring to your appointment. If you have multiple family members, we will need a complete set for each person in your family.
The following forms are required for each patient in our office:
- Patient Registration – Basic Information including address, contact numbers, responsible party and insurance information
- Patient Dental History - History related specifically to your dental health
- HIPAA Consent - By signing this form, it gives us your consent to use and disclose your protected health information to carry out treatment, payment activities, and healthcare operations.
- Medical History – General medical history, including surgeries and hospitalizations, allergies, etc
- HIPAA Notice - Notice describes how health information about you may be used and disclosed and about how you can get access to this.
