Forms
Online Patient Registration Forms
Our online forms use the Adobe Acrobat Plug-in to allow patients the convenience of completing their health history and registration forms from home or work. Please CLICK HERE to download the plug-in from Adobe's web site if it is not already installed on your system. [place the adobe acrobat plug in so it can open when they click here]
Once you have downloaded, printed, and filled out the following forms, bring them in at the time of your visit.
- Caries Risk Assessment Form
- Health History Form
- Insurance Information Form
- Patient Financial Policies
- HIPAA Compliancy Notification
- Acknowledgement of Receipt of Notice of Privacy Practices Form
- Medical / Dental Release Form
Update Forms
- Health History Update Form
- Change of Address/Phone Update Form
- Insurance Update Form
Consent Forms
- Consent to Treat Form
- Release of Records Form
- Nitrous Consent Form
- Oral Sedation Consent Form
- IV Anesthesia Consent Form
- Hospital General Anesthesia Consent Form
- Orthodontic Treatment Consent Form