PATIENT FORMS

Please print, fill out, and bring these forms with you to your first appointment.






FINANCIAL POLICY

Payment options and late charge acknowledgement.


MEDICAL HISTORY

Please tell us more about your medical history so that we can safely address your dental concerns.


HIPAA COMPLIANCE

Describes your patient rights under the law.


NOTICE OF PRIVACY PRACTICES

Details how we handle and protect your private information.


COVID-19 DISCLOSURE

Describes information that must be taken into consideration prior to treatment during the COVID-19 pandemic.


NEW PATIENT REGISTRATION

Please provide your contact and insurance information.






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+1555 6761 020



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