New Patient Form
To make your appointment more successful, please send your completed forms to us before your appointment
- Please Email Completed Forms to [email protected]
- Please Send a Copy Front and Back of your Drivers License
- Please Send a Copy Front and Back of Your Dental and Medical Insurance
- To view and edit PDF documents, we recommend Adobe Acrobat Reader which can be downloaded free from the Adobe website: https://get.adobe.com/reader/
- Patient-QuestHH (7) (1)
- Hippa Consent
- Hippa Privacy Rule ( This is only for you to read and knowledge to sign the Hippa Consent)
There is a $50 fee for no-show appointments or appointments canceled with less than 48 hours notice. For procedure appointments there is a $150 cancellation fee. This will not be covered by your insurance company and must be paid prior to rescheduling.
We understand there are times when you must miss an appointment due to unexpected circumstances. However, when you don’t call to cancel an appointment, you may be preventing another patient from getting much-needed treatment.