top of page
Patient Forms
Following are the new patient forms that would have to be completed by a parent or a court appointed legal guardian at the first visit. We recommend you print and fill them in advance of your appointment to hasten your check in process. Please note that separate sets of forms will be needed for each child and we recommend calling the office if you have any questions.
1. Patient information and health history
2. HIPAA notice of privacy
3. Consent for dental procedure
4. Insurance information and office policy
5. Consent in absence of parent
PATIENT INFORMATION AND HEALTH HISTORY FORM
HIPAA NOTICE OF PRIVACY
CONSENT FOR DENTAL PROCEDURE
INSURANCE INFORMATION AND OFFICE POLICY FORM
CONSENT IN ABSENCE OF PARENT FORM
bottom of page