Patient Forms
Electronic Patient Form Instructions
Step ONE: Click the button below to download the forms. Select "Save File."
Download Patient Registration Forms
Step TWO: Locate the saved PDF and open using Adobe Acrobat Reader.
Step THREE: Type in your personal information, print the forms and bring them to your first appointment.
Note: Our forms require Adobe Acrobat Reader. If your computer does not have this software, it is available for free download here: https://get.adobe.com/reader/
All The Forms
We have made all of our patient forms available to you in one location as Adobe Acrobat 5 files. For your safety and convenience, we recommend printing and completing these forms in the comfort of your home.
Please remember to bring your completed forms with you for your first appointment. If you have any problem getting these files to print properly, please call our office and we will gladly send or fax them to you.
- Pre-Operative Instructions for Dental Surgery (Form 1 of 10)
- Medical History Update Form (Form 2 of 10)
- Medical Consultation & Physician Report for Dental Surgery (Form 3 of 10)
- Disclosure and Consent--Dental & Oral Surgery (Form 6 of 10)
- Nerve Injury Disclosure & Consent (Form 7 of 10)
- Post-Operative Instructions Following Dental Anesthesia/Surgery (Form 8 of 10)
- Acknowledgment of Privacy Practices (Form 10 of 10)
- Implant Consent Form (if required)
- Bisphosphonate Consent Form (if required)
A note about bisphosphonate and denosumab medications:
Osteonecrosis of the jaw (ONJ) is a rare but serious side effect of certain medications that target the bone. These medications are bisphosphonates and denosumab. You may be prescribed these medications if you have: multiple myeloma or other cancers; cancer that has spread to the bone; or, osteoporosis or osteopenia (a weakening of the bones that can lead to fractures/broken bones). The information found through the link below explains ONJ and answers some frequently-asked questions:
https://www.mskcc.org/cancer-care/patient-education/osteonecrosis-jaw-onj