Patient Forms

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

• Medical History 8 years old and younger- PDF
• Medical History 9 years old and older- PDF
• Registration Form - PDF | Word
• Office and Financial Policy - PDF | Word
• HIPPA Notice of Privacy Practices - PDF | Word
• Authorization for Minor Child Accompany - PDF | Word
• Frenectomy - PDF
• Pre Treatment Instructions- PDF
• Post Treatment Instructions: Extractions- PDF
• Post Treatment Instructions: Frenectomy- PDF
• Post Treatment Instructions: Fillings- PDF
• Social Media Consent Form - PDF
• New Patient Introduction Packet  - PDF

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