Patient Forms

You may access the following forms to assist us with your care. Please print and fill out the following forms, then bring them to your appointment.  All new patients should arrive 15 minutes prior to their scheduled appointment time.

For All Patients

• COVID-19 Form

Orthodontic Forms

• Financial Agreement
• HIPAA Acknowledgement
• Insurance
• Notice of Privacy Practices (do not need to print)
• Orthodontic Acquaintance
• TMJ (only for patients with TMJ/Jaw Joint evaluation appointments)

Pediatric Dentistry Forms

• Financial Agreement
• HIPAA Acknowledgement
• Insurance
• Notice of Privacy Practices (do not need to print)
• Social and Health History

For Existing Patients

• Periodic Exam Update (current patients only)

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*These forms require Adobe Acrobat Reader. Click the Adobe logo above to download.