Instructions for New Patient Forms

Please Download, Review, and fill out all new patient forms prior to your first appointment

Please bring the following three forms to your first appointment

• The Health History
• Written Financial Policy
• Consent for Use and Disclosure of Health Information

Authorization for Release of Dental Records

• Please send us a signed copy of this form 48 hours prior to your appointment
• You may email us a picture of the form, scan the form and email us a PDF, deliver it by mail, or drop it off in person
• This form allows us to obtain current x-rays from your prior dentist.
• If we do not receive this form 48 hours prior to your appointment, you may be required to pay for new x-rays out of pocket.