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Patient Registration:
You are encouraged to print and fill out our Patient Information and Medical History Forms at home before your first visit with us. You may mail them or fax them to our office.

These are PDF files, you must have Acrobat Reader installed on your computer to view them. If you do not have Acrobat Reader please click here to download a free copy.

      Smile Analysis Form

      Patient Medical History Details

Forms:
Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed and how you can get access to this information.

Please review it carefully. The privacy of your health is important to us.

In our efforts to comply with the Health Information Privacy Act, HIPPA, we need to be certain that we guard your privacy according to your wishes when it comes to your family, friends and co-workers.

      Notice of Privacy Practices Policy

      Acknowledgement of Receipt of Notice of Privacy Practices

      Consent For Use and Disclosure of Health informantion

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