Dental Forms

Dental Patient Health History Forms

Below are the dental forms and dental consent forms we use in an easy-to-download and print format. Many of our patients prefer to fill these out at home and simply bring them to their appointment. We have found that this is less stressful and more streamlined for our patients and that it makes for a less hectic and more enjoyable dental visit.

If you are a new patient, please download and print the Health History forms, Insurance, Notice of Private Practice, Private Practice Acknowledgment forms. All are listed below as links to download. Please go to our Contact Us page for a mailing address or Fax to the following numbers:

Downtown: (816) 421-0356
Independence: (816) 795-6732
Plaza: (816) 531-0559
Please follow up your fax to confirm receipt of forms – thank you

Health History

Update Insurance

Notice of Private Practice

Private Practice Acknowledgment

Apply Today for Care Credit: www.carecredit.com

If you are transferring to another dental office, please download and print the Copy of Patient Record Request form below.

Patient Record Request Form

 

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