Online Forms
If you're unable to view our .pdf forms, you may download the Adobe Acrobat Reader here.
New patients: please print and fill out the Registration, Health History, and "Hippo" forms below. If you need to have X-rays transferred to our office, fill out the Records Transfer form as well (first page only) and take, fax, or mail it to your previous dentist. Ask them to forward the films before your appointment with us. (A few uncooperative dental offices charge a fee to do this for you.)
If you have the forms filled out in advance, it really helps us staying on schedule. As an incentive, we're offering a $7 discount for non-insurance patients who arrive with all the forms filled out properly. Please remind us about the discount as we don't want to forget to give it to you!
Please note that these forms cannot be filled out on-line, you must print them, then fill them out and bring them with you. In the future we will add the capability to fill out the forms on-line encrypted.
"Hippo" Form--Acknowledging Receipt of Privacy Policy(PDF)
Records Transfer Request (PDF)
The following two forms should not be printed out, but you should click on them and look them over. The "Notice of Privacy Practices" is written by lawyers, sanctioned by the American Dental Association, and essentially devoid of useful information. Look it over, or read it if you're really bored, and be amazed that so much money was spent by so many to say so little. The "Privacy Explanation" is our brief explanation of what the "Notice of Privacy Practices" is all about. You should actually read this, and if you have questions, discuss them with us in person. But again, please don't waste paper printing these two forms - they do not require signatures, and will just go into the trash.
