Patient Forms
Please complete all applicable forms and bring with you to your first appointment.
- Office Policies
- New Patient Form
- Current Patient Yearly Update Form
- Medical History Form
- CBCT/3D Imaging Referral Form
- Sliding Fee Application
- Sliding Fee Application - Spanish
- HIPAA Notice of Privacy Practices
- Medical Records Release Form (Note that a fee will be charged if you are requesting the records for yourself. There is no charge for sending records to another facility).
- Patient Bill of Rights
If you'd like a copy of the MEND telemedicine forms that you will sign electronically before your first telemedicine visit, please click here.