Folding

1. •First fold horizontally.

Referral Card

1. •Referral Card  2.3 MB
   

2. If you have run out of referral cards, please call us for more.  Or, in a last-minute pinch, you can print one out.

New Patient Forms

Patient History Form

1. •Front Page
   

2. •Back Page
   

3. Please print both pages on a single sheet of paper.  If you are unable to print, please visit our office for a form or call us to request we mail you one.
   

Please Read

1. •Office Policies
   

2. •HIPPA Privacy Rules
   

Optional Reading

1. •Notice of Privacy Practices
   

2. •DMFS

Patient History Form for Pediatric Dentistry

1. •Front Page
   

2. •Back Page
   

3. Please print both pages on a single sheet of paper.  If you are unable to print, please visit our office for a form or call us to request we mail you one.
   

Parents Please Read

1. •Office Policies
   

2. •HIPPA Privacy Rules
   

Optional Reading for Parents

1. •Notice of Privacy Practices
   

2. •DMFS

1. •Then fold vertically.