First timers area

Welcome to our office!  We are happy that you have decided to bring your child to Dr. Pat's office for an enjoyable dental experience.  Dr. Pat and her Team look forward to meeting you at your initial visit to our office.

Forms

As you know, there is always the required paperwork. For your convenience, we have made everything available to you online.  Please read the instructions below.

Of course, if you have any questions, we'd be glad to answer them. Either email or call us. Also, check out web site help for assistance in viewing or downloading the following forms.

First - HIPAA
First, we have to satisfy the government with regards to HIPAA.
After reading our Notice of Privacy Practices,
we need you to print the Acknowledgement of Receipt of Notice of Privacy Practices.  After printing, please complete and sign this form, and bring it with you to your initial appointment.

If you'd like even more information , please see our HIPAA page in the parents section.

Next - The Instructions
You may pre-register with our office by filling out our secure online Patient Registration Form and Health History Form. All  are in a PDF format.  After you have completed the form, please make sure to press the Submit button (once) at the bottom to automatically send us your information. On your first visit to our office, we will have your completed form available for your signature. The security and privacy of your personal data is one of our primary concerns and we have taken every precaution to protect you.

PC Users: Our online form is a PDF document that uses Adobe Acrobat Reader plug-in that allows you to conveniently submit documents from home or work. Please download the free Adobe Acrobat Reader from Adobe's web site if it is not already installed on your system. It is important that you have the latest version of the reader to successfully use our online form.

Mac Users: You must open and submit the form in a Safari Browser with the latest Mac operating system. It is also important to 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 Adobe Acrobat Reader plug-in from Adobe's web site. You must OPEN the Adobe Reader Application after installation and make Adobe Reader your DEFAULT SAFARI PLUG-IN for viewing PDF files.

And Now It's Time To Type!

Registration
First we need some information...

Health History
Now we need some history ...

Birth - 5 years old Health History

Age 6 - 15 years old Health History

Dental Visits

Regular dental visits are crucial to maintaining a healthy smile. Take your child to see the dentist by his or her first birthday. Although this may seem early to begin dental visits, the dentist can explain how the child's teeth should be cleaned at home, how diet and eating habits affect teeth and provide methods to ensure that sufficient fluoride is received.

During the first visit, the dentist will examine your child's mouth for tooth decay, growth, and developmental conditions that may pose a problem in the future. The dentist will explain how to clean the child's teeth at home and methods to ensure your child gets the right amount of fluoride.

(Source: www.ada.org. American Dental Association. Chicago. 1997)