Patient Forms

We offer both an online registration option as well as forms that are available to download and complete before your child's appointment. Please complete your child's registration prior to their appointment and be sure to bring your child's insurance card to the appointment.

If you are unable to complete your child's new patient forms either online or with the forms below, please plan to arrive 10-15 minutes early for your child's appointment so that you can complete registration in our office.

Online Registration

Please click on the button below to complete and submit your child's patient forms online before your child's visit.

Patient Portal

Forms For Downloads

Please print and complete the appropriate patient forms prior to the appointment. Be sure to bring the completed forms with you to your child's appointment.

Patient History Form

Patient History Form -Spanish

Permissions to Accompany Patient

Permissions to Accompany Patient - Spanish

Oral Sedation Form

Oral Sedation Form - Spanish

Sedation Consent Form

Sedation Consent Form - Spanish

X-ray Refusal Form

X-ray Refusal Form - Spanish

Fluoride Treatment Refusal
Form

Fluoride Treatment Refusal
Form - Spanish