Patient Forms

Please print and complete the office forms below prior to your child's dental appointment.  This will save you a little bit of time.  There are  3 pages we would like you to fill out and bring with you:    Parent & Insurance Info, Acknowledgement of Privacy Practices, and Financial Policy. 

It is not necessary to bring the Notice of  Privacy Practices Forms, just the Acknowledgement. 

Please do not hesitate to call us if you have any questions.

817-784-1000

We're looking forward to seeing your                               

* Parent & Insurance Info

* Acknowledgement of Privacy Practices

* Financial Policy

*Notice of Privacy Practices page 1 (patient copy)

(You do not need to bring this page to our office)

groovy grins!

*Notice of Privacy Practices page 2 (patient copy)

(You do not need to bring this page to our office)