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Patient Forms

New Patient Online Forms

If you are a new patient, please prepare for your first appointment by completing our Parent/Guardian Registration and Patient Registration forms anytime prior to your appointment. Follow this link to our Online Patient Forms. Enter the patient's name and appointment date to gain access to the forms. If you are completing forms for more than one child, you will need to complete the forms for one child at a time, returning to the sign-in page (accessed via the link) and entering the name and appointment date again for each additional child. 

Thank you!

Printable Forms

If you prefer, you may download and print our forms to complete at home and then bring them with you to your appointment. 

1. Parent/Guardian Registration Form 

2. Patient Registration Form

Notice of Privacy Policy

The Health Insurance Portability and Accountability Act (HIPAA) requires that health providers keep your medical and dental information private. You may access our full Notice of Privacy Policy here

If you’re unable to read PDF files, you can download Acrobat Reader free from Adobe.

usdiAmerican Dental AssociationAmerican Academy Of Pediatric Dentistry