PATIENT FORMS

Simply click on any of the links below to open a PDF of your desired form. You may fill-in/complete the form electronically, then hit “SEND” at the bottom of the form to immediately return it to us. You may also print the form and fill it in manually to be mailed, dropped off at the clinic or brought in with you at you next scheduled visit.

Notice of Privacy Practices
Acknowledgement of Receipt of Notice of Privacy Practices
Consent for Use and Disclosure of Health Information
Authorization for Release of Dental Information
Adult Patient Questionnaire
Child Patient Questionnaire
Patient Dental and Medical History
Information for Surgery

If you have any questions or issues at all with viewing, downloading, printing or understanding your patient form, contact the clinic immediately and we will be happy to assist you.