Consult Room

Patient Forms

Registration information is needed for each individual seeking care within our practice. For your convenience, we have provided the required patient forms here on our website. You have the option of completing the forms and bringing them to your dental appointment for a more efficient wait time, or you can arrive to your appointment 20 minutes prior to your scheduled time to complete the forms in our office. Every patient must complete the following forms before we can begin working with you:

– Adult Registration (as applicable)
– Child Registration (as applicable)
– Medical History Form
– Insurance Estimations, Billing & Financial Options
– Appointment Cancellation Policy
– Notice of Privacy Practices
– Notice of Privacy Practices Acknowledgement

**In addition to the forms above, please bring a current photo ID & your current insurance card (if applicable)**

Depending on your specific situation, the following forms may also be helpful in meeting your treatment needs:

– Record Release Form (required to obtain your dental records from a previous provider)
– Proxy Consent for Minors Form
– Dental Power of Attorney