Patient Forms

When you come to our office for the first time we ask that you complete a patient information and health history form.  This information is important in our ability to give you the care you need.  Your medical information can alert us to watch for specific dental conditions that could affect or be affected by your overall health.  Ultimately, our desire is for you to enjoy not only excellent dental health, but to safeguard your total health as well.

Any personal information you give us is kept in the strictest confidence according to the conditions outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA). It will not be shared with anyone without your written request.

When you come to the office we realize that you don’t generally have your records or other information, such as insurance company accounts or certain medical information, with you.  To make things easier for you we have provided this form for you, below. Please click on the Patient Information Form button, print it out and complete it at home where you have your personal and medical information.

When you come in for your visit, please just bring this completed form with you. This is a two-page form so please complete both pages.

Of course, if you should ever have questions, please call us or bring your questions with you so we can answer them for you.

(Note: this form requires that you have Adobe® Reader® installed on your computer.  Most computers come with this program preinstalled.  If you don’t have the latest version of this program you can download a free copy by clicking on the Adobe® Reader® button below.  Download instructions are at the site.  Thank you.)