Our Forms Brand new Patient Forms to complete Family information (1 form per family) Patient medical history (1 form per child) HIPAA and Financial agreement form (1 form per family) Please read HIPAA information and Dental material below Informed Consent form (1 form per family) Health screening form (1 form per child) This form is to be filled out 1-2 days prior to your child's appointment Update forms to complete every 3 years Patient medical history (1 form per child) HIPAA and Financial agreement form (1 form per family) Please read HIPAA information and Dental material below Informed Consent form (1 form per family) COVID-19 Emergency treatment consent (1 form per child) This form is to be filled out 1-2 days prior to your child's appointment Other form (to be filled out only if our team instruct you to) Non-parental consent Silver Diamine Fluoride (SDF) Infant Tongue/Lip tie assessment Infant Tongue/Lip tie release consent Child Tongue/Lip tie assessment Child Tongue/Lip tie release consent Referral form (for doctors to fill out) Referral form (to submit form online) Referral form (to print and fill out) Information for reading Health Insurance Portability and Accountability Act (HIPAA) Dental Material First Aids for Dental Emergencies Caries balance Contact us! Call us: (707) 685-9819 ORText us: (707) 474-4543 ORFill out the form below Which is bigger, 2 or 8?
