Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

  • Medical History 8 years old and younger- PDF
  • Medical History 9 years old and older- PDF
  • Registration Form - PDF 
  • Office and Financial Policy - PDF 
  • HIPPA Notice of Privacy Practices - PDF 
  • Authorization for Minor Child Accompany - PDF 
  • Credit Card Authorization Form - PDF
  • Frenectomy - PDF
  • Pre Treatment Instructions- PDF
  • Post Treatment Instructions: Extractions- PDF
  • Post Treatment Instructions: Frenectomy- PDF
  • Post Treatment Instructions: Fillings- PDF
  • Social Media Consent Form - PDF
  • New Patient Introduction Packet  - PDF

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