Patient Forms

COVID-19:

• Patient Screening Form
  • First column marked "Self-Assessment" to be completed be each patient ~2 weeks prior to each appointment
  • If you are a minor: This form will also need to be completed for (1) parent or guardian if he/she will be accompanying you to your appointment

For New Patients:

Please complete all of the following forms. Please click the "Submit" button at the upper left corner upon completion:

• New Patient Registration Form 
• New Patient Medical History Form
• New Patient Appointment Agreement and Dental Material Acknowledgement Form
• New Patient Financial Agreement
• New Patient HIPAA Consent

Please review the following documents:

• HIPAA Notice | PDF
• Dental Materials Fact Sheet | PDF

For Existing Patients:

• Medical History Update
• Photo/Video Consent Form
• Teledentistry Consent Form

Treatment Consent Forms:

• Preventative Sealants Consent Form
• Composite Filling Consent Form
• Bridge(s) and Crown(s) Consent Form
• Implant Supported Restorations (Fixed) Consent Form
• Occlusal Guard Consent Form
• Non-Surgical Periodontal Treatment (SRP) Consent Form
• Surgical Periodontal Treatment Consent Form

Oral Surgery Consent Forms:

• Oral Surgery and Dental Extraction Consent Form
• Bone Graft Consent Form
• Implant Placement Consent Form

Orthodontic Treatment Consent Forms:

• Orthodontic Start/Banding Consent Form
• Orthodontic Deband/Retention Consent Form

If you’re unable to open PDF files, you can get Adobe Reader® for free.