For your convenience, all of our New Patient forms are available to you online. Please complete the New Patient Registration, Dental and Medical History, HIPAA Consent, and Financial Policy forms before your first visit.
If you wish to fill out the forms online, below are links to each form. They will bring you to another page where you can fill it out to the best of your knowledge and then submit it directly to us. This is also mobile friendly!
- Patient Registration – Online Form
- Dental and Medical History – Online Form
- Informed Consent for General Dental Procedures – Online Form
- Informed Consent for HIPAA Compliance – Online Form
- Financial Policy – Online Form
If you would rather not fill it out online, you can also choose to download the below PDFs and print it out and fill it out at home, or download them to fill it out digitally at your leisure. If you fill it out digitally, you can send it to our email at firstname.lastname@example.org. If you cannot do any of the above, it is not a problem! Just make sure to come 10-15 minutes before your appointment to fill out the paperwork in office.
- Patient Registration
- Dental and Medical History
- Informed Consent for General Dental Procedures and HIPAA Compliance
- Financial Policy
- X-Ray Policy
Please print and fill out the above forms and bring them to your first appointment.
- Authorization of Dental Records and Radiographs Release
Please print and use this form to request dental radiographs and records from your previous dentist.