Click on each link below to read and print our forms:

• HIPPA Privacy Notice and Consent Form
• Patient Information & Dental Insurance Form
• Medical History Form
• All 3 Forms Together

lease download and fill out our Patient Information Form, Medical History, and the Consent Form prior to your first visit, or if any of your information has changed since your last visit.

Insurance ~
ur office will fill out an insurance form and accept payment from your Insurance Company for their part of your dental fee, but you must fill out the Dental Insurance Information on the bottom of the Patient Information Form. The balance of your fee is due at the time of treatment. We can also request a pre-determination of your benefits from your insurance before beginning any extensive treatment. We can accept out-of-state insurance but we cannot accept international insurance.

e accept Visa and Mastercard.