Patient Forms

New Patient Forms:

We are excited to welcome you in to our practice and cannot wait to meet you!  Please take a moment to complete our New Patient Information Form and HIPAA Privacy Consent Form prior to your first visit. (Please complete both forms)

New Patient Information Form

HIPAA Consent Form

Other helpful forms:

Retainer Options Form

(Review retainer information, review options for additional sets of retainers, and select your preference)

For your convenience, we offer electronic and automatic payment options from a checking/savings account or through a debit/credit/FSA/HSA card. Download the appropriate form here:

• Automatic Payment Authorization (Credit, Debit, FSA, HSA)*
• Electronic Payment Authorization Form (Checking or Savings)*

*These forms require Adobe Acrobat Reader. Click the Adobe logo to download.