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.
mailed to you or have misplaced them, you may click on the links below to
print out the required forms.
| All new patients must fill out these 5 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:
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: |
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Federal law requires all patients to receive a copy of the
NOTICE OF PRIVACY PRACTICES:
NOTICE OF PRIVACY PRACTICES:
| New Patients receive this free 367 page book about dental treatment |
