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Patient Forms

Downloadable Forms

To save yourself some time on the first appointment, you can fill out our patient forms at home. Download and print our patient forms here. If you have any questions, please feel free to call our office.

Note: These documents are in Adobe® PDF format. They require Adobe Reader to be viewed. If you do not have Adobe Reader, you can download it for free by clicking here.

Health History

Dental Registration and Health History

Financial Policy

Our goal in discussing financial arrangements relative to your dental needs.

HIPPA Information

How the Health Insurance Portability and Accountability Act (HIPAA) will affect your next dental visit.

HIPPA Authorization Form

AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION PURSUANT TO HIPAA [This form has been approved by the New York State Department of Health]

ADA Claim Form

American Dental Association Dental Claim Form

Informed Consent

Informed consent form for orthodontic patients.

Diet Chart

The foods to avoid and eat, Orthodontic Diet Chart.

Life with Braces

For orthodontics patients, Life with Braces.

*Individual results are not guaranteed and may vary from person to person. Images may contain models.