Patient information
It is an important part of our dental practice’s philosophy to understand your needs values, and concerns. For this reason, we ask, you to please share the following information about yourself.
Consent for Use and Disclosure of Health Information
By signing this form, you allow us to use/disclose information necessary to carry out treatment, payment, and healthcare operations.
Medical History
Provide a brief medical history to allow us to better and more efficiently treat you.