There are many areas of prevention and care that are unique to children which the pediatric dentist is specifically trained to identify, treat and prevent. That is why many parents wisely choose a pediatric dentist for their child's dental needs, just as they choose a pediatrician for their medical needs.
INSTRUCTIONS: To download and print the forms below, click on the printer icon to the left of the form name. For more information, and a description of the form, click on the purple form name link below.
Health History (2.9 mb)
The Health History form contains patient and parent names, phone numbers, and contact information, account information, insurance information, and dental and medical history information. Download Health History Form
Receipt of Privacy Practices (201 kb)
The Acknowledgement of Receipt of Notice of Privacy Practices form indicates that the patient or parent of the patient has received a copy of the office's Notice of Privacy Practices. Download Receipt of Privacy Practices Form
HIPAA Privacy (116 kb)
The HIPAA notice of privacy practices form describes how health information about you may be used and disclosed and how you can get access to this information. Download HIPAA Privacy Form
NOTE: All documents are in Adobe Acrobat PDF format. In order to view and print these forms, you must have Adobe Acrobat Reader installed on your computer. To download Adobe Acrobat Reader for free from Adobe's website, please click here or on the icon below.
