Forms
Information Update
Please fill out this form if you have any changes in your insurance, contact information, or patient’s medical history. (It is required once every 6 months and will be texted to you the day before your routine cleaning appointments as well.)
Family Information UpdateNew Patients
If you are bringing in a SINGULAR NEW PATIENT please fill out this complete packet:
New Patient PacketIf you are bringing in MULTIPLE NEW PATIENTS please fill out a medical history form for each individual patient, but only one consent packet for all of the new patients together.
First patient’s medical history:
Medical History: First New PatientEach addition patients’ medical history:
Medical History: Each Additional NPOne consent packet with all the new patients’ names written on each page:
New Patients: Consent PacketNon-Guardian Consent to Sign for Treatment
If someone other than a parent or legal guardian will be bringing your child to their dental appointment please complete this form:
Non-Guardian Consent to SignDownloadable Forms
Referral Slip
