Patient Forms

If you are a new patient to our office, the attached file contains our new patient bundle with forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your medical needs more quickly than completing them on your arrival. Thank you and please call our office if you have any questions at all.

Patient Forms ( Print & Complete All Forms Prior To First Office Visit)

HiPAA - Notice of Privacy Practices

New Patient Registration - Adult

New Patient Registration - Child

MEDICAID - Visit Documentation

MEDICAID - Carries Risk Assessment Tool

MEDICAID -Dental Risk Assessment Questionnaire - Spanish

MEDICAID - Dental Risk Assessment Questionnaire - English

MEDICAID - Oral Health History Questionnaire - Spanish

MEDICAID - Oral Health History Questionnaire - English

MEDICAID - Visit Policy

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.