Patient Forms

Help us get to know your child!

Please prepare for your first appointment by completing our new patient information forms. Download the forms to your computer to complete at home. Then bring them with you to your first appointment.

  1. Health History Form
  2. Recare Visit Form
  3. Permission Designated to Another Adult
  4. Permission to Treat a Minor Child Who Drives Themselves
  5. Local Anesthesia & Nitrous Oxide (Laughing Gas) Consent
  6. Consent for the use of Oral Sedation & Local Anesthesia
  7. Pre-sedation Instructions
  8. Pediatric Dentistry Informed Consent
  9. Protective Stabilization Consent
  10. Photograph and Publicity Consent
  11. Privacy Practices Information pdf

These documents are in Adobe PDF format. If you're unable to read PDF files, you can download Acrobat Reader free from Adobe.

American Dental AssociationAmerican Academy Of Pediatric DentistryCare Credit