First Visit Forms

To save you time, please complete prior to your visit all 3 forms (New Patient Registration, Dental Questionnaire, Medical History) in their entirety.

Click Here to Fill Out Child New Patient Forms Click Here to Fill Out Adult New Patient Forms

form-01New Patient Registration Form

Our doctors are always happy to accept new patients. Please print out the New Patient Registration Form and bring the completed form with you to your appointment or complete the online form. Our New Patient Registration Form asks for your personal demographics and insurance information. This information allows us to serve you better and submit bills to your insurance company.Please remember you will still need to bring your insurance card to your appointments.

form-02New Patient Registration Form for Dependents

Our office strives to provide an atmosphere where young adults and children feel comfortable. Please print out this form and bring the completed form with you so you can save up to 20 minutes on your initial visit with your dependents or complete the online form. If you or your dependents have any concerns or individual needs please let us know as soon as possible so we can make your visit as comfortable as possible.

Please remember you will still need to bring your insurance card to your appointments.

form-03Dental Questionnaire

Please print out the Dental Questionnaire Form and bring the completed form with you to your appointment.

form-04Medical History Form

A complete and accurate medical history is an important part of diagnosis and treatment planning.  Please fill out this medical history form  or print so that we can provide you with optimal dental care.

form-05Notice of Privacy Practices

Our practice respects your privacy. We understand that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so. We’ve posted our Notice of Privacy Practices to give you the opportunity to become more familiar with our privacy policy.