New Patient

Here you can complete our new patient document: The form will be directly forwarded to our secure server. No need to print or download!

 

General Anesthesia

Here you can complete our general anesthesia documents, such as digital forms, agreements and other important files:

Pediatrician Forms

 

Myofunctional Clinic

 

Pediatric Dentistry & Oral Surgery

 

Request School Dental Certificate

Please complete this form to request a School Dental Certificate for school registration. Use a separate form for each child. We will email you a certificate promptly.

 

Request Dental Records

Please complete this form to request Dental Records. Use a separate form for each child. Please note that x-rays will be forwarded via email and allow 48 hours for our response. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file.

 

Request Orthodontic Clearance

Please complete this form to request orthodontic clearance. Use a separate form for each child. Please allow 48 hours for a completed form. You will need to enter your child’s information before accessing the form to ensure our software matches the form with your child’s digital file.

 

Request FSA / HSA Receipt

Please complete this form to request an FSA/HSA receipt. Please allow 24 hours for your request to be completed.

 

Request Dental Well Visit Report Card

Please complete this form to request a Dental Well Visit Report Card. This form is a summary of your child’s dental well visit in the event you were not able to be present during his/her visit. Please allow us 48 hours for a response.

 

Request Prescription Refill

Please complete this form to request a prescription refill. Please allow 24 hours for your request to be completed.

 

HIPAA Policy

Here you can view, print or download our HIPAA Policy documents. Rest assured your privacy is our priority. For more information, you can contact
our front desk.

Banner_Site-01.jpg