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We value new patients and welcome you to our practice. To
become established as a patient, there are several forms that you must
complete. These forms are designed to accomplish a number of
necessary functions.
- General Information form allow us to know
how to contact you.
- Insurance Information form helps us to
file your insurance for you.
- Medical Information and Medical History
forms are necessary to help us provide the best quality care without
unnecessary compromises to your health.
- HIPAA form is required by law and is
designed to help protect your privacy.
- Financial Policy form provides information
about our payment and insurance policies.
- Authorization to Release Dental Records
form allows us to obtain your dental records from your previous or
current dentist.
After you open the forms, please fill them out
completely. You should print the forms and bring them with you to
your appointment.
You will need to have Adobe Acrobat Reader in
order to view these forms.
INSTRUCTIONS
- Make sure that you have Adobe Acrobat
Reader installed on your computer, or install Adobe Acrobat Reader
by clicking the above link.
- Click the
Download & Open Complete Patient Forms
link here.
- The New Patient Forms will automatically
open in your browser.
- Please fill out the forms completely and
accurately. You may go back and change any of the information
before you print them. Use the TAB key to change from one
entry field to the next. Continue until you get to the last page.
- When you have competed all of the forms,
there will be two option buttons at the bottom of the last page. The
Print button will allow you to print the forms so that you
can bring them with you to your appointment. The Reset button
will clear ALL entries.
Individual forms listed below may be downloaded by clicking the link:
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