New Patient Form

IMPORTANT NOTICE
Kindly complete and electronically submit each of the 6 forms below.

Online Form Instructions:

1. Please begin with Form #1: Health History.
2. When one form is completed, you will be automatically sent to the next form to be completed.
3. Complete all 6 Forms and get access to our Special Discounts Offers.

Click to fill out patient forms online

1. Health History
2. Smile Evaluation
3. Total Health Questionnaire
4. Hippa Form
5. Oral Cancer Screening Consent Form
6. Informed Consent Form

Download Patient Forms

1. Health History
2. Smile Evaluation
3. Total Health Questionnaire
4. Hippa Form
5. Oral Cancer Screening Consent Form
6. Informed Consent Form