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. Contact us. Also, check out web site help for assistance in viewing or downloading the following forms.
First - HIPAA
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.
After you have completed the form, please make sure to press the Submit button (once) to automatically send us your information on our secure web site.
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.
And Now It's Time To Type!
Registration
First we need some information...
Birth – 17 years old Patient Registration
18 Years and older Patient Registration
Health History
Now we need some history ...
Birth - 5 years old Health History
Age 6 - 15 years old Health History
Not Dental/Medical Advice. This website is for informational purposes only. This information does not replace professional advice, diagnosis, or treatment. If you have questions regarding a dental/medical condition, always seek the advice of your dentist or other qualified health professional. Developments in dental research may impact this information. If you think you may have a medical emergency, call your doctor or 911 immediately.
