header
drop shadow
drop shadow

Patient Forms

In order to make the new patient registration process as quick and easy as possible, we have posted all of the forms we require you to fill out upon arriving. Please click on the various links below and print the forms. Fill in all requested information and bring the forms with you on the day of your appointment. If you have any difficulties with completing the forms, please call (305) 538-8835.

These forms are in .pdf format. If you are unable to view you will need to download the necessary plug-in. get_adobe_reader.gif 

 
Form 1: Agreement to Treatment

Form 2: Agreement to Treatment (en español)

Form 3: Patient Payment Policy

Form 4: Patient Policy Acknowledgement

Form 5: Patient Policy Acknowledgement (en español)

Form 6: Patient Verification on Income

Form 7: Privacy Notice

Form 8: Registration Financials

Genetic Screening Questionaire - Español 
Genetic Screening Questionaire - English

DENTAL PATIENTS FORMS
Dental Medical History Form - Español
Dental Medical History Form - English
Dental Notice of Privacy Practices
Patient Confidentiality - Español