Please take a minute to fill out the online form. If you would rather print the forms, just print out the highlighted forms and bring them with you to your dental appointment.
Please note that x-rays will be taken on FIRST appointment unless you bring current x-rays with you or have them emailed to our office. They can be emailed to
firstname.lastname@example.org OR email@example.com
Medical History Form
- Insurance Information & HIPAA Acknowledgement [PDF]
- Patient Referral [PDF]
- No Show / Cancelation Policy [PDF] (this is for your information)
- Financial Understanding [PDF]
- Notice of Privacy Practices HIPAA [PDF] (this is for your information)
If you're unable to open PDF files, you can get Adobe Reader® for free.