Patient Forms

Please download, print, and fill out the appropriate forms before your first appointment. Each patient needs to fill out a patient history, financial policies, and an acknowledgement of the HIPPA Privacy Act form. Then either mail them or bring them with you in order to expedite the appointment.

Adult Intake Form

• Adult Intake

Child Intake Form

• Child Intake

Financial Policies and Information

• Financial Options

HIPAA – Notice of Privacy Practices

• HIPAA Privacy Notice

HIPAA – Acknowledgement of Receipt of Notice of Privacy Practices

• HIPAA Acknowlegement

Limited Dental Warranty

• Limited Dental Warranty