Patient Forms

Please print, complete, sign, and return the following four required pages prior to your new patient appointment:

•	New Patient Registration (Required)
•	New Patient Medical History (Required)
•	Financial Policy (Required)
•	HIPAA Privacy Practices - Acknowledgement to Sign (Required)
•	Notice of HIPAA Privacy Practices
•	Release of Information Authorization - Optional

•	Instruction for Night Guard Care
•	Instructions for KOR Overnight Bleaching
•	Postoperative Instructions for Extractions
•	Postoperative Instructions for Extractions with Bone Graft
•	Postoperative Instructions for Dental Implants
•	Liquid Diet Suggestions
•	Blender Ideas
•	Oral Sedation Instructions