Patient Forms

Before Scheduling Your Child's Dental Treatment

The following items must be completed and received before your child's dental treatment can be scheduled.

Oral Rehab Booking Information

On the first page of the Oral Rehab Booking Information form, you must indicate your medical insurance, not your dental insurance information.

You must supply a copy of your medical insurance card, front and back, a minimum of one week prior to the appointment. (If not received, you may be responsible for the facility and anesthesia fees.)

If You Are Other Than the Natural Mother or Father and Have Legal Responsibility for the Child

We require a copy of the document appointing you legally responsible. This information is necessary because only the legally responsible party can sign the Consent for Anesthesia and Conditions of Admission on the day of surgery.

Patient Packet

Practice Contact Information