Patient Forms

For your convenience, you may download, print and fill out the following forms and bring them to your next appointment:

• Your Dental Assessment
• Patient Registration Form
• Medical History Form
• Smile Evaluation
• Acknowledgement of Receipt of Notice of Privacy Practices
• Consent for Use and Disclosure of Health Information
• Notice of Privacy Practices
• Consent for Treatment
• Financial Policy

These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo to download.