Patient Forms

 

New 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, save, and email them to yourneighborhooddentist15@gmail.comor you can bring the completed forms with you to your appointment.

Patient Information

HIPAA Consent

Financial Policy

Photo 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. 

Prior to your first appointment, please obtain your most recent dental records (including all x-rays) from your previous dentist. This is necessary for us to complete a comprehensive evaluation and to provide you with the best plan of treatment.  If you do not have access to your previous records, we will need to take the necessary x-rays in order to complete your examination. You will be responsible for the cost of the x-rays if your insurance company will not pay for them.

Please feel free to call our office if you have any questions or concerns. 


Your Neighhorhood Dentist
30301 Schoenherr Rd, Ste B
Warren, MI 48088
586-573-4970