Patient Forms and Information

Patient information forms are available for download below.

 

Welcome!
Your initial appointment will consist of a thorough examination. Radiographs are necessary for a thorough and accurate diagnosis. If you have recent radiographs from a previous dentist, please request that they be sent to our dental office prior to your visit. If you prefer, you may bring your radiographs to your initial appointment. During your visit we will review your medical history, examine your x-rays, teeth, gums, and jaw alignment and provide an oral cancer screening. Please note that if you require antibiotic prophylaxis for any medical condition (i.e. total joint replacement, prosthetic heart valve etc.) please take the appropriate dose prior to your dental appointment. Depending on the health of your gums, a dental cleaning with our hygienist may be completed during this initial visit.

New Patient Forms
Please print and complete the following six forms: Patient Registration, Dental and Medical Form (2 pages), Financial Policy, Consent for Use of Disclosure of Health Information, and Acknowledgement of Receipt of Notice of Privacy Practices. Bring your completed forms to our office for your initial visit.

Download New Patient Forms


If you would like to review our Notice of Privacy Practice (HIPPA), please select "Notice of Privacy Practice" below. This form does not need to be printed and is available for your review.

Download Notice of Privacy Practice


As a courtesy to our patients with dental insurance we file insurance claims from our office. To allow us to provide you with accurate information about your insurance benefits please bring your insurance information as well as picture ID to your visit.


CareCredit Financing
Our office is pleased to provide interest free financing through CareCredit. To learn more about this option please click here.

carecredit

A Refreshing Approach to Dentistry.