Patient Forms

Please take a moment to fill out our online patient survey.

• Survey

Click the document links to automatically download the PDF forms* to your computer.

• Adult patients: Download the "Adult Registration Form".
• Parents of child patients: Download the "Child Registration Form".
• For Adult & Minor Patients: Download and Read the "HIPAA Privacy Policy".
• For Adult Patients: Download the "HIPAA Adult Consent Form".
• For Parents of Child Patients: Download the "HIPAA Minor Consent Form".
• Update forms: "Orthodontic Insurance Information" form to provide updated insurance information.
• General dentists: Download the "Referral Form" to communicate evaluation notes and directions for your patient.

Type the information in the fields on each PDF page.

Print out the completed forms and bring these documents to the office on your first visit.

 

*These forms require Adobe Acrobat Reader to view. If you do not have Adobe Reader already installed on your computer, click the Adobe logo above to download.