Patient Forms
Adult New Patient Registration
If you’ve never visited our office before, the Adult New Patient Registration form is the form for you! This will help you get a head start on all the necessary
Child New Patient Registration
If your child has never visited our office before, the Child’s New Patient Registration form is the form for you! This will help you get a head start on all the necessary paper work. Click below to download the form.
NIH APPLICATION
For your convenience, you can download and complete the NIH Application Form before your visit. Please fill out all required information carefully and bring the completed form with you to help us make your appointment process faster and smoother.
Click below to download the application form and get started!
SLIDING FEE DISCOUNT PROGRAM
We are committed to making quality dental care accessible for every family. Our Sliding Fee Discount Program may help reduce the cost of treatment for eligible patients based on household income and family size.
Download the application form below to review eligibility requirements and apply for the program before your appointment.
General Information About Our Forms
All of our forms require Adobe Reader which is a free download. By having Acrobat Reader you will be able to fill out our forms on your computer and then print them (note: depending on your connection speed forms may take a couple of seconds to open).