If you need to fill out our forms offline, please fill out all forms below and bring them with you on your first dental appointment. The Notice of Privacy Act form is for your records only we do not need you to bring this form into the office.

 

If you are transferring from another office please fill out the form that is for x-ray transfer authorization and send this to your previous dental office so they can submit any and all x-rays that they may have on file; x-rays older then 1 year will be obsolete; if they are bitewings. However, if your previous dentist has a panoramic film or full mouth series on file; we will accept this x-ray because it is good for 3 years.