Smiles Dentistry for Kids

Patient Health History Forms

Patient Health History Forms

Please take a minute to print and fill out the patient information forms before your first appointment:

» Credit Card Authorization Form [PDF]

» Financial Policy Form [PDF]

» HIPAA Consent Form [PDF]

» Parent/Legal Guardian Information Form [PDF]

» Child’s Health History Form [PDF]

If you're unable to open PDF files, you can get Adobe Reader® for free.

Back to top

About Us | For New Patients | Dentistry for Kids | Education | Contact Us | Home | Site Map

Web Site Powered by Sesame 24-7™