Online Forms

New Patient Forms

Health History Form

You may preregister with our office by filling out our secure online Patient Registration Form. After you have completed the form, please make sure to press the Submit button 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 it.

Insurance/Guarantor Information Form

• Insurance/Guarantor Form
  Fill out if you have dental insurance or patient is under 18 years of age.

Notice of Privacy Policy

• Notice of Privacy Policy
• Acknowledgement of privacy practices
  After reviewing privacy policy, print out acknowledge, sign and bring into office at first visit.

Release of Health Records

• Release of Health Records Form
  Print, fill out, and mail, or bring to office for release of records to another entity.

Technical Note:

Our online forms use the Adobe Acrobat 5 Plugin to allow patients the convenience of completing their health history and registration forms from home or work. Please download the free plugin 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 plugin, in order to successfully use our forms.