Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

New Patient forms for Adults:

Health History- Adult

Financial Policy

Acknowledgement and Consent Form - for Notice of Privacy Practices

New Patient forms for Young Adults (13-17):

Health History- Young Adult

Financial Policy 

Acknowledgement and Consent Form - for Notice of Privacy Practices

New Patient forms for Children:

Health History- Child

Financial Policy

Acknowledgement and Consent Form - for Notice of Privacy Practices

Informed Consent Forms:

Discussion and Consent for Extractions

Discussion and Refusal of Periodontal (Gum) Treatment

Discussion and Consent Root Canal Treatment

General Discussion and Consent Form

Refusal of Dental/Radiographic Examination