Patient Information

Online Forms

At the time of your first visit, you will be asked to fill out and sign some forms to provide us information about you. For your convenience, you may download these forms here and prepare them in advance. Feel free to fax or bring in the completed forms.

Patient Information Form --This form provides us with your basic information, including name and contact information,insurance information, and brief medical history.

Anesthesia Consent -- This form provides an explanation of our anesthesia policy as well as providing us with your permission to use anesthesia as appropriate.

Our Privacy Practices -- This form defines the patient privacy practices that we follow. 

Health Information Consent -- This form provides us with permission to use and disclose your health information to carry out treatments, payment activities, and healthcare processes. Please read "Our Privacy Practices" first, and then fill in and sign this form.

These forms are pdf documents which require the Adobe Reader software. You most likely already have this software on your computer. However, if you have difficulty reading the notice, please click here to install Acrobat Reader.

 

 

Please Contact Us with any questions regarding your dental care.

  • All dental specialties
  • 24/7 emergency care
  • Sedation dentistry and laughing gas
  • Convenient weekend and late weekday hours
  • By appointment

Follow us on Twitter