You may print out your "New Patient" forms ahead of time. Just click on the links below in order to print each form. Then complete the forms at home and bring them with you to your first appointment.
Adult new patients fill out the following forms.
- (a) Registration Form
- (b) Dental History Form
- (c) Medical History Form
- (e) HIPAA "Acknowledgement of Receipt of Notice of Privacy Practices" Signature Form
- (f) HIPAA "Notice of Privacy Practices" Form (review)
- (g) Office Payment Policy (review)
Children under 18 fill out the following forms.
- (a) Registration Form
- (d) Child Dental Medical History Form
- (e) HIPAA "Acknowledgement of Receipt of Notice of Privacy Practices" Signature Form
Pecan Park Dental patient forms are in Adobe Acrobat PDF format and require Adobe Acrobat Reader to view. You may obtain Adobe Acrobat Reader FREE at http://www.adobe.com/products/acrobat/readstep2.html
