Office Forms

You can find all the forms here that you will need to fill out for your 1st visit. Please download the documents below and then fill out and sign them to bring to your 1st visit. Please read the notice of privacy practices if you wish. You do not need to sign anything on the notice of privacy practices.

Click the the icon next to the form to download a Microsoft Word document that you may print out

New Patient Information

Please fill out both pages. Fill out the medical history section as thorougly as you can.

General Consent form

This form is our general consent form for visits to our office.

Notice of Privacy Practices

Read this document. There is nothing to sign. HIPPA requires that this document is offered to all patients.

Acknowledgement of Privacy Practices

Sign this after you understand our notice of privacy practices.

Release of Information Authorization

This form allows you to authorize us to discuss you child’s dental information with anyone that may bring your child to an appointment other than the guardians. Note: this allows discussion only, not consent.

Scheduling Policy

Please sign our form that explains our scheduling policy

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