Patient Forms

If this is your first time visiting our office, please click each of the links below to download the necessary paperwork. Once downloaded, you can fill out the forms and email them to yourneighborhooddentist15@gmail.com, or you can bring the completed forms with you to your appointment.

Patient Information

Health History

Financial agreement and HIPAA Consent 

Completing these forms ahead of time will allow us to begin your appointment at the scheduled time. If you are unable to fill out the forms prior to arrival, we ask that you arrive at least 15 minutes before your scheduled time, to ensure that you are seen as quickly as possible. 

 This web site uses files in Adobe Acrobat Portable Document Format  (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.