Forms
Please review, download, and fill out the relevant forms for your appointment. These forms will also be available at the office, however, completion before your appointment will help the staff in both speed and sanitation during your appointment. Please give us a call if you have any questions.
Click “Open” for a downloadable copy. You may print them out and bring them, or email them to us.
COVID-19 Required Appointment Forms
Reopening COVID-19 Response
Instructions and guidelines for appointments provided by the American Dental Association (ADA), Centers for Disease Control and Prevention (CDC), and Occupational Safety and Health Administration (OSHA).
Read before filling out Patient Screening Form and Consent Waiver.
COVID-19 Treatment Consent Waiver
Waiver consenting to treatment and acknowledging the extensive precautions taken by our office.
Fill out and bring to your appointment.
Standard Visit Forms
Updated Insurance Coverage Information
Complete this form to update your insurance coverage information if it has changed since your last visit.
New Patient Forms
Health History
A comprehensive health history form.
Dental History
A comprehensive dental health history form.
Confidential Information Form
Complete this form to proved all confidential information necessary for your care.
HIPPA Acknowledgement of Receipt
This acknowledges that you have received the notice of privacy practices.
HIPPA Notice of Privacy Practices
This notice describes how dental/health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Office Payment Policy
Information and signed agreement acknowledging payment policies.