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New Patient Forms

Below you will find the forms you will need for your first visit with us.  To print these forms just click on each link below.  The file will download.  Just click on print and fill out the form and bring it with you on your first visit.


Adult new patients will need:                                         Child new patients will need:

1.  NP ADULT FORM.pdf                                                                 1. NP CHILD FORM.pdf

2.  Dental History 12 1 2009.pdf                                                       2. Dental History 12 1 2009.pdf

3.  Payment Policy                                                                            3. Payment Policy

4.  NOTICE OF PRIVACY PRACTICES2.                                       4. NOTICE OF PRIVACY PRACTICES2.pdf

4a.  HIPAA Authorization 2016.pdf                                                 4a . NOTICE OF PRIVACY PRACTICES2.pdf

5.  Notice of Privacy 12 1 2009.pmd.pdf                                          5. Notice of Privacy 12 1 2009.pmd.pdf 

6.  Email and cell phone reminder card.pdf                                      6. Email and cell phone reminder card.pdf

7.  Medical History.pdf                                                                      7. Medical History.pdf







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