Please print these forms, fill out by hand and bring to your first appointment, or download the forms, fill them out online and email the completed forms to firstname.lastname@example.org.
We accept most dental insurances. We are providers for Blue Cross Blue Shield along with some of the Federal plans, and providers for the Delta Dental insurances. Please be advised that these are all different types of insurance plans and not all plans under the same company offer the same coverage.
Forms you will need to print or download:
- Patient Registration
- Medical History
- Consent to Contact
- Acknowledgement of Receipt of HIPAA
- Financial Agreement
- No Show Policy
All forms can be downloaded as editable PDFs and emailed back to email@example.com once you have entered your information.