For your convenience, you may print the NEW PATIENT FORMS below and bring completed forms to your first appointment. We look forward to meeting you!
- Health History Form
- Information About Payment and Insurance
- HIPPAA Notice of Privacy Form (keep this copy for your records)
- Acknowledgement of Receipt of Privacy Practices
- Release to Transfer Records to Our Office
Consent Forms:
- Parental Consent to Treat – This form gives permission for someone other than a parent or legal guardian to bring your child to their dental appointments (ex: grandparent, friend, sibling, significant other)
- Consent to Share Information – This form gives permission for us to discuss treatment/appointments as well as pick up documents/cases with someone other than yourself (Ex: to share information with a parent/caregiver if over age 18, have a friend pick up x-rays, etc.)
If you are a CURRENT PATIENT of ours and need your records transferred to another office, please send us the completed form below: