Patient Forms

If you are 18 or older, please print and complete the packet titled:
Adult New Patient Forms

If your child is 17 or under, please print and complete the packet titled: Child New Patient Forms

All forms need to be completed in advance of your appointment time. As part of our new COVID safety protocols, a staff member will come to your car to accept the completed paperwork, prior to bringing you in the building. New patients without fully completed paperwork will be rescheduled due to appointment time constraints and safety protocols.

Please also see our safety protocols policy on our COVID 19 Info tab.

Thank you for your understanding.

Permission for Text and/or Email Form
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Appointment Cancelation Policy

In these times, it’s important to provide notice if you need to make a change to an existing appointment. Our office has confirmation protocols, but keep in mind, if we can’t reach you, it is your responsibility to give notice before making an appointment change. We want to see as many of our patients as we can and late cancellations create lost patient time. To avoid this lost time, we ask for 48 hour business day notice or a missed appointment fee will apply.

Please be on time, we value our patient’s time as much as our own and it may be cause for you to be rescheduled. A missed appointment fee will apply.

Charges will be assessed in the amount of $50 for a late or missed appointment for hygiene. A charge of $150 will be assessed for a for a late or missed appointment for restorative work or any surgery, not including any non-refundable sedation payments.

Fees to be paid before rescheduling family. For your convenience in contacting us, we have 24 hr. voicemail or you can email us from our website.

Late cancellations or missed appointments can result in release from the practice.