Patient Forms

When your appointment is scheduled, a text link will be sent to the parent/guardian to complete the new patient paperwork. We highly recommend completing these forms in advance to allow for a smoother and expedited check-in process. If you need to complete the paperwork in the office, a tablet will be provided before your appointment. Please note that separate sets of forms will be needed for each child, and we recommend calling the office if you have any questions.

1. Patient information and health history
2. HIPAA notice of privacy
3. Consent for dental procedure
4. Insurance information and office policy
5. Consent in absence of parent

PATIENT INFORMATION AND HEALTH HISTORY FORM

HIPAA NOTICE OF PRIVACY

CONSENT FOR DENTAL PROCEDURE

INSURANCE INFORMATION AND OFFICE POLICY FORM

CONSENT IN ABSENCE OF PARENT FORM

To Book An Appointment Contact Us on 724-774-1920

Patient Forms

Shelly Brown