Patient Forms

Save time at your first visit by completing these forms in advance

Complete Forms Before Your Visit

Downloading and filling out forms ahead of time helps us maximize your appointment time and get you started on your smile journey faster!

1

Gather your information

Youll need insurance, medical and dental info

2

Complete

Fill out forms carefully and completely

3

Submit

Submit completed forms and we will check your insurance before you come in.

Available Forms

Click to download each form

Patient Information Form

Basic information about you and your medical & dental history & insurance

Click Here to fill the form

Required

HIPAA Privacy Notice

Information about your health information privacy rights

Click to sign

Formulario de Información del Paciente (Español)

Información básica sobre usted y su historial médico

Haga clic aquí para completar el formulario

Tips for Completing Your Forms

Complete all forms legibly and accurately

Bring your insurance card if you have coverage

List all current medications and allergies

Include emergency contact information

Sign and date all forms

Bring forms to your first appointment or arrive 15 minutes early to complete them

For Minors: A parent or legal guardian must complete and sign all forms. Please bring your child’s insurance card and a valid ID to the appointment.

Need Help? If you have questions about any of the forms, please don’t hesitate to call our office at (631) 665-5580. We’re happy to assist you!