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Patient Forms

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We too wish there wasn’t so much paperwork, unfortunately we are obligated to subject you to this.

Dental Health Club

No Insurance? No Problem! If you’re a patient of record and wish to enroll in our Dental Health Club, please complete the form below.

DHC Enrollment

Patients of Record and New Patients

Welcome to our new secure electronic forms system! (instructions on how to use it)

We are asking ALL our patients to fill out the following electronic forms prior to their next appointment:

  1. New Patient Registration Form
  2. Medical and Dental History
  3. HIPAA
  4. Financial Policy (you can see it here)
  5. Insurance Verification Form (only if you have commercial dental insurance)

The information you enter will be transferred securely and directly to your patient chart. On future visits, you’ll be able to update these forms only with what has changed.

We respectfully request that the forms be submitted 3 days prior to your appointment. This will enable you to spend less time in our office.

What you’ll need:

  • The patient’s name and their appointment date, to access our Secure Electronic Forms Site (instructions on how to use it)
  • To fill out the forms, a device that can open a webpage — a computer, a tablet, or a smartphone — whichever one you’re most comfortable typing with.
  • Time: 15-30 minutes to fill out 5 forms, depending on the complexity of your medical/dental history and your level of comfort typing and navigating the forms.

Access our Secure Electronic Forms Site through this link: (the link will also be sent to you via email 5 days prior to your appointment)

Steps and screenshots are included here.

Helpful hints:

  • The information you enter in a form will only be saved after you click on the Submit button.
  • If you don’t have time to fill out all the forms in one sitting, you may reopen the Secure Electronic Forms Site by clicking on the link some other time.
  • Chrome browser: On some Windows systems the “Submit” button doesn’t work. Please right click on the link above and choose “Open link in incognito window.”
  • If you’re a patient of record, you may ignore “Date of previous visit.”
  • Under Home Phone, please enter your Preferred Phone.
  • If a text box is too small, you can grab the chevron on the bottom right (see below) and expand it

Forms Hint

Patient Portal

Through our new Secure Patient Portal you’ll be able to:

  • Use 2-way texting to communicate with us
  • Send and receive secure emails
  • View upcoming appointments
  • Request an appointment (use comments to request a time, or if you’d like to be on a waiting list)
  • Manage notifications
  • And other capabilities we’re implementing.

To access your secure patient portal, please create an account. You will need the patient’s name and date of birth.

Password requirements: 8-20 characters in length
At least 1 number
At least 1 uppercase letter
At least 1 lowercase letter
At least 1 of these special characters: !@#$%^&*