patient forms

Patient Forms

Please take a minute to print and fill out the patient information form before your first appointment:

  • Patient Information (Child, under 18) PDF
  • Patient Information (Adult, 18+) PDF
  • Dental and Medical History PDF
  • Records and Insurance Consent PDF
  • HIPAA Form PDF
  • Acknowledgement of HIPAA Form PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

AAO ADA ABO Smiles Change Lives
Website Powered by Sesame 24-7™ | Back to Top | Site Map