Forms
If you plan to become a patient and do not want to wait
for the forms to be mailed to you or have misplaced
them, you may click on the links below to print out the
required forms.
Patient Registration Form
Options & General Risks of Dental Treatment
Health History Form
Records Release Form
Retreatment Options
Dental Insurance Information
Finance Agreement
Medical Assistance Program Waiver

All new patients must fill out these 6 forms:
Fill out applicable forms only if you have 3rd party benefits:
Fill out this form only if you are considering
replacing your existing dental work with different materials:
Generally, we prefer payment in full at the time of service.  

However, we will consider financial arrangements for a person who
needs extensive treatment and has a good credit rating:
Forms other HEALTHCARE PRACTITIONERS may need:
Dental Materials Testing Form
Federal law requires all patients to receive a copy of the
NOTICE OF PRIVACY PRACTICES:
Notice of Privacy Practices
Medications List
HIPAA Acknowledgement Form