You may use these forms for a faster check-in process before your first appointment. If you have already filled out these forms with our office, however, there is no need to fill them out a second time, provided that you have visited our office within the past year.
Please click on the following two links to download the files, then print and fill out the forms. Don’t forget to bring your filled-out copy of both forms with you when you visit our office for your appointment. Please be aware if you initiate any email correspondence to us containing personal information without using an encryption service, your personal information may be at risk. Therefore, you may want to make your initial email to us as inquiry only, in which case we will respond to you with our encrypted email, allowing you to then safely send your personal information via our encryption service.
*In order to avoid having to reschedule your appointment and/or being charged for additional radiographs for which your insurance may not pay, please make certain we have your imaging/xray information from your referring dental provider BEFORE your scheduled appointment. Imaging information is crucial to the accuracy of your exam appointment. If we do not have that information the day of your exam, we will take imaging at our office at your expense. For greatest resolution, we request that the imaging/xray information be sent digitally via email or copied on disc. Paper copies of the imaging will be accepted if digital transmission is not possible.*
If you wish to be considered for same day exam/procedure with sedation, please print, fill out these forms and bring by the office prior to scheduling for pre-approval by the Doctor.
For everyone’s safety, only the patient and their guardians/parents or spouse will be allowed beyond our reception area into our clinic. MINOR CHILDREN, unless they are a patient, are not allowed beyond reception, so please make appropriate arrangements. Except in emergencies, any adult or minor with signs or symptoms of a contagious illness will be restricted from access to our office. We greatly appreciate your cooperation!
PLEASE FILL OUT ALL PAPERWORK IN BLUE PEN!
