The addition of flouride to the public drinking water is officially listed as one of the top ten greatest public health achieve-ments of the 20th century according to the CDC (Center for Disease Control).

Below you will find links to our "Patient Registration" and "Patient Health History" forms. You can speed up your office visit by printing these and completing them in advance. Just click the links, print the forms, fill them out and bring them with you to your appointment. For those of you who would prefer to type your information directly into the pdf forms electronically and then print them, please choose the files marked as "editable".

As a new patient, in addition to completing the registration and health history forms you will be asked to sign three forms that outline the policies of our office. The Financial Policy form contains important information about payment terms and responsibilities. The Privacy Policy (HIPPA) form outlines the ways we protect the privacy of your personal information. The Cancellation Policy form provides information about breaking or changing appointments. The forms are available below for review. You can also go ahead and print these forms and bring them with you if you wish.

New Patient Forms
-Patient Registration Form (pdf format)
-Patient Health History Form (pdf format)

Editable New Patient Forms
-Editable Patient Registration Form (pdf format)
-Editable Patient Health History Form (pdf format)

Financial Policy
-Financial Policy Form (pdf format)

Privacy Policy
-Privacy Policy Form (pdf format)

Cancellation Policy
-Cancellation Policy Form (pdf format)

If you need a free copy of the Adobe Acrobat Reader please click the "Get Adobe Reader" icon below.


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