Patient Forms

http://www.dreamstime.com/royalty-free-stock-image-happy-patient-dental-chair-image15761286If you are new to our office, welcome!  Please print out our Medical History, Financial Policy, Assignment of Benefits and Notice of Privacy Practices Acknowledgment.  These forms can be filled out entirely, signed and brought with you to your first appointment in our office.  The Notice of Privacy Practices is also available for you to print and keep.

Please click the links below to access the forms:

Medical History             

Financial Policy

Assignment of Benefits

Notice of Privacy Practices Acknowledgement


Notice of Privacy Practices

 

 

If you need us to release your records or x-rays to another office, you will need to sign our Records Release Form.  Please print below, fill out entirely and bring to one of our offices or email it to office@coledentistry.net.

Records Release Form