Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

• Dental and Medical Histories
• Patient Information
• Financial Policy
• Privacy Practice Acknowledgment (HIPPA)
• Privacy Practice Acknowledgment (signature page)

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

NOTICE OF PRIVACY PRACTICES

The federal government requires all dental office to make patients aware that they have rights regarding the use of their personal health information.  Our Notice of Privacy Practices and our consent forms are available for your review at the front desk or here online in our Patient Forms section.  This notice takes effect September 2013 and will remain in effect until we replace it. It describes how health information about you may be used and disclosed by our practice and how you can obtain access to this information