New Patient Forms/Privacy Notices

Make Your First Visit Easy!

We have made our new patient forms available on this website for your convenience!  You can print out and complete our new patient forms at home before visiting our office. Bringing your completed forms in with you will save time and help expedite your check in process at your first visit. Of course you can always wait and fill out the forms when you arrive at our office. If you choose to wait and fill out the forms at our office, please arrive for your appointment 15 to 20 minutes before your appointment time.

If you have any problems with the forms, simply call our office and we will gladly send or fax them to you.   We look forward to meeting you and helping you with you dental needs!

The forms here are Adobe Acrobat files. If you don't have Adobe already, you'll need the free Acrobat Reader to view and print them.  Free download below.

Below is the link to our New Patient Information Form. Please print and fill out both pages, sign and bring them with you to your first appointment.

New Patient Information Form 2 Pages.pdf

Please read our Insurance Policy, print, sign, and bring it with you to your first appointment.

Insurance Policy.pdf

Please read the 2 pages of our Notice of Privacy Practices (you may print them out if you wish) and then print out the Acknowledgement of Receipt of Notice, sign, and bring with you to our office.

Notice of Privacy Practices

Acknowledgement of Receipt of Notice

The "Signature on File" card is so that we don't have to ask you for your signature on every insurance form every time you or someone in your family needs to file an insurance claim. Please print then sign your name and check all of the boxes. Also list everyone of your dependents who may be covered by your insurance.

Signature on File

Adobe Acrobat Reader is a free download.
Download Adobe Acrobat Reader

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.