Please complete the following four forms. After you have entered your data on each form you may either click the submit button and the form will be emailed to our office, or you can print the forms and bring them into the office on your next visit.
New Patient Form
The Information requested on the New Patient Information form is important to our records and your health. Please fill the form out completely.
New Patient Information Form
Dental and Medical History Form
By filling out and signing this form you are providing us with the necessary dental and health information to provide you with the proper dental care.
Dental and Medical History Form
Consent and Disclosure Form
By signing this form, you consent to our use and disclosure of your protected health information to carry out treatment, payment activities, and healthcare operations.
Consent and Disclosure Form
Financial Policy Form
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