Below are the required client forms we use in our office which must be completed before your appointment begins. The Notice of Privacy Practices is informational--it discusses how your personal health information (PHI) may be used--your signature is not required on it. The Client Intake Registration and the Consent forms must be completed and signed by you.
Please READ/PRINT/SIGN these Client Forms:
1. Notice of Privacy Practices (READ)
2. Client Intake Registration & Health Form (READ/PRINT/SIGN)
3. Consent for Use and Disclosure of PIH (READ/PRINT/SIGN)
4. Consent for Cosmetic Teeth Whitening and Waiver (READ/PRINT/SIGN)
To view these forms may require that you download and install the free Adobe Acrobat Reader if it is not already installed on your machine.
Save time by printing these forms at your home or office and reading and completing them at your leisure. Please print legibly and remember to bring them with you to your appointment. Arrive about 10 minutes before the scheduled start time so that we may review them together and so that I may ask you questions and so that you can ask me any questions that you may have.
Please arrive 15 minutes early if you intend to complete these intake forms at our office and so that we have time to discuss their contents. People who have extensive medical history and/or health issues may require additional time. Please use your best judgment. Waiting to complete the intake forms at your scheduled appointment time will require service time to be reduced to fit.
Clients who have already completed and submitted the intake forms but who have experienced substantial changes in their health since their last visit (OR if it has been longer than a year since the last visit) will need to resubmit the forms so that we may keep files current.
FOR MORE INFORMATION