Patient Forms

For New Patients:

Below you will find links to the patient forms that we ask for you to fill out before your first visit.  You will be asked to update your medical history at every visit in order for Patriot Dental staff to keep informed of any changes in your history that may impact your dental care.  To download just click on each link and print.

Please read our HIPPA Patient Privacy Policy before filling out our forms.  Thank You!

HIPPA Privacy Notification (read only)

HIPPA Consent and Release of Information(download and print)

Patient Information Form (download and print)

Patient Medical History (download and print)

Financial Agreement(download and print)

 

For Current Patients:

Authorization for Release of Dental Records and Xrays