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Patient Forms

All of our intake forms can be filled out, signed, and emailed directly from your browser. Alternatively, you can download / print each form and then send to us via email. Send to: [email protected].

Patient Information(View PDF Version)

Medical & Dental Health History(View PDF Version)

Financial Information(View PDF Version)

Smile Analysis(View PDF Version)

Patient Acknowledgement & Consent(View PDF Version)

Authorization for Release of Dental Health Information(View PDF Version)

Dental Release to RDA(View PDF Version)

Notice of Privacy Practices