Patient Registration Forms

When your child comes for the first time, we will need to complete and file the following forms:

1. Medical History: Includes any medical conditions, allergies and surgeries your child may have had.Please include your child's pediatrician information and previous dentist if applicable.

2. Hippa Forms: These forms related to the protection of your private information. These forms are provided at the office and you can sign them electronically. There are 2 forms.

3. Office Policies:  Office expectations are outlined. Be aware that we file your dental claim as a courtesy with your insurance, but final decision is made by your dental insurance carrier once the claim is submitted. Responsible parties are responsible for any unpaid insurance portion.

4. Behavior Management: Our goal is to build a trusting relationship between your child and our staff. This form outilnes the different strategies we use  in order to achieve that.

5. Oral Sedation: When your child has a treatment that requires oral sedation, you will need to sign this form. Please read it carefully to become aware of the different implications of this kind of sedation.

For your convenience, you may download, print and fill out the following forms and bring them to your next appointment:

adobe

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

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