
Forms for your Child's Visit
Patient Forms
You may read our Statement of Privacy Practices here.
New Patients
Registration, Health & Dental History
Information needed: child’s name, parents’ names, insurance, dental and medical history. Describes our privacy policy, information disclosure, general treatments (opt-out) and needs your signature.
Current Patients
Health & Dental History Update Form
Information needed: child’s and parent’s names. We ask that this be completed anytime your child’s health or dental history, insurance, address, phone number or email address has changed.
Refusal of Treatment
You have the right and the obligation to make decisions regarding your healthcare . Your dentist can provide you with the necessary information and advice, but as a member of the…
Release of Records Request
Need to request records? Use the Records Release form to have your child’s records sent to you or another provider’s office.
Still Have Some Questions?
We have the answers. If you can’t find what you’re looking for on this page, we recommend the following: