Patient Forms

Midlothian Pediatric Dentist

In order to provide you with the most efficient new patient experience, please download and complete the forms that apply below and bring them to your child’s first appointment. This will allow the new patient process to run more quickly and smoothly for both our practice and you.

Our team will take comprehensive records and address any concerns or questions you may have. If you are having problems downloading the forms, please contact our office and we will gladly send them to you.

New Patient Forms
General Consent Form
Financial Agreement Form
HIPAA Consent Form & Notice of Privacy Practices