Patient Forms

• If you are a new patient to our office, below are the files containing our new patient bundle with forms that need to be filled out before you arrive at our office.  Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  If you are unable to print these forms, please arrive at least 15 minutes prior to your appointment time, to complete in office.  Thank you and please call our office if you have any questions. 315-376-3121.

New Patient Forms/HIPPA Form

Notice of Privacy Practices​ (HIPPA)

 

• To request records and/or x-rays from your previous dentist, please print the "Authorization to Release Information Form" below, fill it out and send it to your previous dentist prior to your appointment.  They will send your information directly to us!
  

Authorization to Release Information Form

  

• If you are an existing patient, below is the file containing our medical information update form that needs to be filled out prior to the start of your appointment.  Printing it, filling it out and bringing it with you will allow us to attend to your dental needs more quickly than completing it at your arrival to the office.  If you are unable to print these forms, please arrive at least 10 minutes prior to your appointment time, to complete in office.  Thank you 

 Medical Information Form

This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.