patient forms

Patient Forms

For your convenience, you can download the patient forms below. Please take a minute to print and fill out the patient information forms before your first appointment: 

  • Patient Form (Child) PDF
  • Patient Form (Adult) PDF
  • Notice of Privacy Practices (HIPPA) PDF
  • Change of Insurance Forms: Dental Policy PDF  Medical Policy PDF

If your dental and/or insurance benefits change, please notify us as soon as possible so that we may verify your new coverage and file the appropriate claims for benefit reimbursement. For your convenience, you may download and complete the Change of Insurance Forms for submission to our Financial Coordinator. For more information on orthodontic insurance visit our Finance and Insurance page.

  • Cavity Buster's Coupon PDF

For details on our Cavity Buster's Club, click here.

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