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.