Forms

New Patients: Please fill out the New Patient Form and the HIPPA & Financial Release. You can print the forms and bring your completed forms to your appointment or you may download them and email to us prior to your appointment.
To email the forms:
1. Click one time on the form
2. Save to your Desktop
3. Open in Adobe Reader
4. Fill out form
5. Save and Email to [email protected]<mailto:[email protected]>
At your appointment, please bring your State Issued License, and Dental Insurance card. If you have dental insurance, we will need the name, social security, date of birth, and employer of the policyholder.
You are also welcome to scan your paperwork, driver's license, and dental insurance card and email it to us at [email protected] prior to your appointment.
**If you have difficulty with emailing the forms back to us, you are always welcome to print them out and bring them to your appointment.**

NPFORM.pdf

HIPPA-FIN.pdf

Record Release.pdf