Patient Forms
Paper Copies
- Download New Patient Paperwork
- Updated Medical History Paperwork for Existing Patients
- Download Records Release Form to transfer x-rays TO our office
- Download Records Release Form to transfer x-rays FROM our office
- Download Parent/Legal Guardian Consent for Treatment Form
- Download Personal Representative Designation Form
- Download 18 and over HIPAA and Personal Health Disclosure Form
- Download Personal Health Information Disclosure Agreement Only (must be signed for disclosure of information of anyone over 18 years of age)
- Download Patient Advisory & Acknowledgement COVID-19
Electronic Copies
- Download Electronic New Patient Paperwork **Can be signed at appointment**
- Download Electronic Updated Medical History Paperwork for EXISTING patients ONLY **Can be signed at appointment**
- Download Electronic Records Release Form to transfer x-rays FROM our office
- Download Electronic Parent/Legal Guardian Consent for Treatment Form
- Download Records Release Form to transfer x-rays TO our office **After finishing, please save and email to the previous dentist.**
- Download Electronic Patient Advisory & Acknowledgement COVID-19