New Patient Information

New Patient Forms
Please print and fill out the below forms and bring them to your first visit.

Adult New Patient Forms

Pediatric New Patient Forms


Medical History Update Form
You will need to update your medical history once every two years to ensure we have the most
up-to-date medical and allergy information on file. If you have been told you are due, or if you
have had any surgeries or hospitalizations since your last dental appointment, you can print the
form below and bring it with you to your next visit.

Medical History Update

Unaccompanied Minors Policy

As of July 2018, our unaccompanied minor policy is as follows:
Any patient under the age of 18 years old unaccompanied to their appointment by a parent or
legal guardian will need a permission form signed by a parent or legal guardian prior to being
treated in our office.

*New patients MUST be accompanied by a parent or legal guardian for their first visit.*

Parents wishing to send a child with a friend, sitter, or family member may use the below form to
authorize dental care for their child(ren). This form will be good for one year, please be sure to
include a good phone number should we need to reach you regarding payment, treatment
needs or scheduling of appointments.

Permission to Treat Minor Form

Please note: payments and copays are due at the time services are rendered; we can accept
payment over the phone for your convenience.