PATIENT FORMS

Focused on your health

Patient Forms

Please print and fill out these forms so we can expedite
your first visit:

FINANCIAL POLICY AND HIPAA

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PATIENT INFO AND HEALTH HISTORY

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In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.

YOUR SMILE MAKEOVER

The most important job you have as a member of your own smile makeover team is to communicate exactly what you don’t like about your smile and how you’d like it to be different. Before the first consultation, give some thought to the following questions:

What do you like or dislike about the color, size, shape and spacing of your teeth?
Are you pleased with how much your teeth show, both when you smile and when your lips are relaxed?
Do you want teeth that are perfectly aligned and a bright “Hollywood White,” or would you prefer a more natural look with slight color, shape and shade variations?
Would you like more or less of your gums to show when you smile?

It is extremely helpful for you to bring in pictures you have collected — of smiles you like, smiles you don’t like, and/or photos of the way your own smile used to look, if that’s the result you’re aiming for. Now is the time to get started on creating a smile that will make you feel as good as you look!