Patient Forms

Please complete the forms below and bring it with you to your new patient appointment. This will save you time on the day of your appointment and allow us to attend to your dental needs more quickly. You may contact our office at any time with questions!

Email and Text Messaging Registration Form: Text Policy.docx

Patient Medical History FormMedical History.docx

Patient Medical History Form (2): Medical History (2).docx

HIPAA Form: HIPAA Form.doc

Financial Policy FormFinancial Policy.docx

Cancellation/No-Show Policy Form: Cancellation Policy.docx

X-RAY Release Form: X-ray Release Form.doc

Treatment Without Guardian Consent Form (for minor patients who will be brought to future appointments by someone other than their legal guardian): Treatment without guardian consent form.docx


 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.


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