Forms to download and fill out...
Please Download, Print, Fill Out, Sign and send
back to us at firstname.lastname@example.org or bring with you at your first appointment.
THE FIRST 6 FORMS plus the Covid-19 Form
ARE REQUIRED FOR YOUR FIRST APPOINTMENT!
Covid-19 Acknowledgement Form
Personal Info and Welcome Info
Please fill out as much as possible, we will review this with you. All info is kept strictly confidential
New Patient Information & Medical History
Please fill out as much as possible, we will review this with you.
Dont forget to add a family member that you give permission for us to speak to about your oral health care.
Informed Consent to begin your exam
This is a general informed consent so that we can conduct a complete exam and diagnosis with you.
Electronic (Text/Email) Consent Form
This gives us permission and direction so we can stay in touch with you.
Informed Consultation Form for
We love pictures and social media, we want your permission to take pictures first for our own records and then for social media posts.
Are you Thinking Cosmetic Dentistry
Fill this form out if you are desire cosmetic dentistry.
Do you think you have Sleep Apnea or Snoring
Suffering from Sleep Apena or snoring..fill this form out.
Please fill out the contact form