These forms are important for clinical care, scheduling, and insurance billing. At your first appointment, time is reserved for review of patient policies, complete paperwork,evaluate dental x-rays, and consult with the dentist about your care. A broken first appointment may affect your ability to be seen in our clinic.
Required Information That Should Be Brought With You at The First Visit
Two (2) forms of Identification
Insurance Card/Proof of Income
Medication List or List of all Drugs, Supplements, or Natural Products
A note authorizing treatment from doctor if needed (See FAQs)
Doctor(s) names and phone numbers
Guardianship Forms for Children or Adults in Guardianship Care
**If your insurance has not been pre-verified, you will be instructed to bring a deposit for your initial treatment.**
**Please print and fill out each form (English or Spanish)**
- Patient registration-English
- Adult health history-English
- Child health history-English
- HIPPA-English
- Under 18 consent-English
- Patient Policy - English
- Patient registration-Spanish
- Adult health history-Spanish
- Child health history-Spanish
- HIPPA-Spanish
- Under 18 consent-Spanish
- Patient Policy - Spanish (Informacion Y Polizas Del Paciente)
**Visit Mobile Clinic section for Mobile clinic paperwork**
Please note, a copy of our privacy policy is available on this website. Click on the link above labeled "Privacy Policy."
Our office fax number is (336) 903-0464.
