Smiles for the Future Pediatric Dentistry
Patient Forms
Thank you for joining our dental family. We look forward to meeting you and your child. Please fill out the following forms prior to your scheduled appointment.
New Patient Forms
Child Forms
- Child Registration (pdf)
- Child Health & Social History (pdf)
- Child Financial Policy (pdf)
- Child HIPAA & Authorization to Release Information (pdf)
- Child Record Transfer From Another Practice (pdf)
Adult Forms
- Adult Registration (pdf)
- Adult Health & Social History (pdf)
- Adult Financial Policy (pdf)
- Adult HIPAA & Authorization to Release Information (pdf)
Other Forms
- Child Health and Personal History Update Form (pdf)
- Adult Health and Personal History Update Form (pdf)
- Parental Consent to Treat Over Age 18 Form (pdf)
If you need any information or have any concerns, do not hesitate to call us.
Thank you for choosing Smiles for the Future to help with your children’s health, growth and comfort.