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.
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of the Bronx
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of Farmingville
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of Hauppauge
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of Port Jefferson
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of Richmond Hill
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of Westchester
Notice of Privacy Practices
Notice of Privacy Practices for Concerned Dental Care of Upper West Side