accessibility ACCESSIBILITY

Patient Forms

 

 

If you are a new patient to our office, the following forms are needed for your first appointment.  Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  If you don't have time to fill them out ahead of time, please plan to arrive 15 minutes before your appointment time to complete them at the office.  If you have dental insurance, please bring your card with you to your appointment.


 Welcome to Our Office

 Patient Registration

 Health History

Acknowledgement of Privacy Practices

NOTICE OF PRIVACY PRACTICES


Has your physician recommended that you take an antibiotic before you have dental treatment due to a joint replacement?  The recommendations have changed, and it may be time to check in with your doctor or orthopedic surgeon.  Print the ADA statement below and take it with you to your next regular checkup.

ADA Statement Regarding Antibiotic Premedication


If you are or will be receiving treatment with Arestin utilizing your medical insurance, there is a new copay assistance program from Orapharma, the makers of Arestin.  If you qualify, you may be able to get your Arestin from the pharmacy at little to no cost to you. Complete the following form and return it to our office to be included with your prescription:

Arestin Copay Assistance Form



 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.
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