Child Patient Packet

Instructions

New child patients’ parents or guardians should follow these steps when their child is becoming a new Family Dentistry patient:

1. Print each form below. (or download the full packed ZIP file)
2. Complete each form.
3. Bring each of the completed forms to your first appointment.

Forms

1. Print Registration Form
2. Print Child Dental/Medical History Form
3. Print Statement of Privacy Practices Form
4. Print Acknowledgment of Privacy Practices Form
5. Print Cancellation Policy
6. Print Financial Policy

Download Child Patient Packet