Patient Forms

New Patient Forms:

We are excited to welcome you in to our practice!  Please take a moment to complete our New Patient Information Form and HIPAA Privacy Consent Form prior to your first visit. (Please complete both forms)

New Patient Information Form

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HIPAA Privacy Consent Form

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Other helpful forms:

Retainer Options Form

(Review retainer information, review options for additional sets of retainers, and select your preference)

Fill Online

 

For your convenience, we offer electronic and automatic payment options from a checking/savings account or through a debit/credit/FSA/HSA card. Download the appropriate form here:

• Electronic Payment Authorization Form (Checking or Savings)*
• Automatic Payment Authorization (Credit, Debit, FSA, HSA)*

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*These forms require Adobe Acrobat Reader. Click the Adobe logo to download.