|
| |
Click here for Internet Smile Whitening Offer
The New Patient forms are in PDF
format, which can be read using Adobe Acrobat Reader. If you do not have Adobe
Acrobat Reader, get a free copy by clicking on the link below.
Adobe Reader
When you have Acrobat Reader, click on the links below to download the New
Patient forms. (If you are on a dial-up modem connection, please be patient - it
may take several minutes). Then print the form, fill it out, and bring it with
you on your first visit. Also, after reading the Notice of Privacy Practices,
print the Acknowledgement form below, sign it, and bring it in, too.
Medical History, page 1.
Medical History, page 2.
Insurance Policy
Notice of Privacy Practices
Acknowledgement
of Privacy Practices
Financial Agreement | |
|
