Patient Forms

New Patients We value your time as well as our own. To save you time when you arrive at our office, we have made it possible to fill out necessary forms in one of two ways: You may fill them out on your computer using your keyboard and mouse, and print them. Once printed, you may fax or mail them to us (see Contact Us) or you may bring them with you to your appointment. You may print the forms and fill them in with a pen. Once complete, you may fax or mail them to us (see Contact Us) or you may bring them with you to your appointment. Please note the following: Child forms should be used for any patient younger than 12 years of age. When filling out the medical and dental history forms, please use the space to the right of the question to explain any question to which the answer is “YES.”

You will need Adobe Acrobat Reader to view our forms, which is a free software available by clicking the Adobe Reader logo below.
Current Patients Please use the forms below to update us on changes of which we need to be aware. You may fill out the form on your computer using your keyboard and mouse, and print the completed form, or print a blank form and fill it in with a pen. Once finished, you can fax or mail the form (see Contact Us) to us or you may bring it to your appointment.

You will need Adobe Acrobat Reader to view our forms, which is a free software available by clicking the Adobe Reader logo below.
Individual Forms You may access other patient forms by clicking on the links below. The form may be filled out on the computer (if applicable) using a keyboard and mouse, and printed as a completed form, or the blank form may be printed and filled out with a pen. The completed form may be sent to us by fax or mail (see Contact Us) or you may bring it to your next appointment. Patient Records Request Form – to have records, x-rays, photos sent to us from a former dentist. Photographic Release Form – permission to use images of a patient where the patient can not be identified (i.e. – photos of teeth, x-ray images, etc.). Identifiable Photographic Release Form – permission to use images of a patient where the patient may be identified by others (i.e. – a full face photo). You will need Adobe Acrobat Reader to view our forms, which is a free software available by clicking the Adobe Reader logo below.