Patient Forms
We would like our patients to print and fill out ALL the forms below and bring them to your first appointment.
- Click here for Patient Medical History.
- Click here for Endodontic Consent and Information.
- Click here for Payment Information
- Click here for our Privacy Policy.
- Click here for our Privacy Policy Acknowledgment.
IMPORTANT INFORMATION FOR NEW PATIENTS: Federal law requires all healthcare practices to obtain, verify, and record information that identifies each new patient. WHAT THIS MEANS TO YOU: When you open/create an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents, i.e. military ID, passport, or other government issued ID. Thank you for your cooperation.”
Technical Note:
Mac Users
You must open and submit the form in a Safari Browser and also have the latest Mac Operating System. It is important you also have the latest version of Adobe Acrobat Reader on your computer in order to submit your form to our office correctly, please download the free Acrobat Reader from Adobe's web site.
PC Users
Our online registration forms use Adobe Acrobat Reader 5 or greater plug-in to conveniently submit your health history and registration information from home or work. Please download the free Acrobat Reader from Adobe's web site if it is not already installed on your system. It is important that you have at least version 5 of the plug-in to successfully use our online registration forms.
