These forms are important for clinical care, scheduling, and insurance billing. At your first appointment, time is reserved for review of patient policies, complete paperwork,evaluate dental x-rays, and consult with the dentist about your care.
Required Information That Should Be Brought With You at The First Visit
Two (2) forms of Identification
Insurance Card/Proof of Income
Medication List or List of all Drugs, Supplements, or Natural Products
A note authorizing treatment from doctor if needed (See FAQs)
Doctor(s) names and phone numbers
Guardianship Forms for Children or Adults in Guardianship Care
**If your insurance has not been pre-verified, you will be instructed to bring a deposit for your initial treatment.**
**Please print and fill out each form (English or Spanish)**
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Patient Registration-English
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Adult Health History-English
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Child Health History-English
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HIPAA-English
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Under 18 Consent-English
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Patient Policy - English
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Patient Registration-Spanish
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Adult Health History-Spanish
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Child Health History-Spanish
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HIPAA-Spanish
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Under 18 Consent-Spanish
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Patient Policy - Spanish (Informacion Y Polizas Del Paciente)
**Visit Mobile Clinic section for Mobile clinic paperwork**
Please note, a copy of our privacy policy is available on this website. Click on the link above labeled "Privacy Policy."
Our office fax number is (336) 903-0464.
