Medical Health Questionnaire
If you want to provide your medical health information to us (optional), please print and complete this form (to the extent you can), and bring it with you to our dental Office or fax it to us.
HIPAA Consent Form
By signing on this form, you agree to the use and disclosure of your health information for treatment purposes, payment activities and healthcare operations of our dental Office.
Medical Record Release Form
If you want to authorize the release of your medical records from your existing health care provider to us or someone other than yourself, please print and complete this form, and bring it with you to our dental Office or fax it to us.