Patient Forms

Please take a minute to fill out the online form. If you would rather print the forms, just print out the forms and bring them with you to your dental appointment. You may also access our online patient registration by clicking the link below.

Online Patient Registration Form

Printable Forms

Insurance Information & HIPAA Acknowledgement
Financial Understanding

Patient Referral
Notice of Privacy Practices HIPAA (this is for your information) 
No Show / Cancelation Policy (this is for your information)
 

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 beth@vipfamilydentistry.com OR heather@vipfamilydentistry.com 

 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.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.