Patient Forms & Consent

1.

This form collects your medical history to ensure your dentist understands any potential interactions between your health and your dental treatment.

2.

This Informed Consent form ensures you understand the proposed dental procedures, potential benefits, risks, and alternatives before making a decision.

3.

This agreement outlines your payment responsibilities, including fees, insurance coverage, billing procedures, and consequences of non-payment.

4.

This form explains your rights under HIPAA (the Health Insurance Portability and Accountability Act) regarding the privacy of your health information.

5.

This form collects your insurance information, so that we may better assist you and maximize your insurance benefit.