Forms to download and fill out...

Please Download, Print, Fill Out, Sign and send

back to us at smilesketchvegas@gmail.com or bring with you at your first appointment.

                                         THE FIRST 6 FORMS  plus the Covid-19 Form
ARE REQUIRED FOR YOUR FIRST APPOINTMENT!

Thanks!

Form #2

Covid-19 Acknowledgement Form

Form #1

Personal Info and  Welcome Info

Please fill out as much as possible, we will review this with you. All info is kept strictly confidential

Form #3

New Patient Information & Medical History

Please fill out as much as possible, we will review this with you.

Form #4

HIPPA Forms

Dont forget to add a family member that you give permission for us to speak to about your oral health care.

Form #5

Informed Consent to begin your exam

This is a general informed consent so that we can conduct a complete exam and diagnosis with you.

Form #6

Electronic (Text/Email) Consent Form

This gives us permission and direction so we can stay in touch with you.

Form #7

Informed Consultation Form for 
Covid-19 Screening 

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

Thanks for submitting!