Patient Forms

patient forms

For your convenience, most of the forms you will need are available here! Filling them out in advance and bringing them with you will save you time and enable you to access the proper information needed before your visit.

NEW PATIENT FORM Welcome! If you are a new patient with Smiles for Kids Dentistry, we ask you to fill out the new patient packet before your first scheduled appointment and bring it in with you. This will help your first visit go smoother, because you will have all the information we need to have your child treated and reduce time in the waiting room. Simply click the link below to download the form to your computer; then print it, fill it out at your leisure, and bring it to your first appointment.

If you are a new family to Smiles for Kids Dentistry, or are now bringing another child or additional children, there is no need to fill out the NEW PATIENT FORM for each child. We request only one completed new-patient form per family and one sibling form for each additional child. Simply click the link below to download the form to your computer, print it, fill it out, and bring it with you on your scheduled visit.

Siblings Packet

SEDATION CONSENT FORM If you have scheduled a visit and have discussed sedation with the dentist, this form provides all the information you need about our methods of sedation, gives us permission to sedate your son or daughter for the scheduled procedure, and includes all the necessary information about what to expect. Simply click the link below to download the form to your computer, print it, fill it out, and bring it with you on the day the procedure is scheduled.

CONSENT TO AUTHORIZE If anyone other than the mother, father, or legal guardian of our patient brings him or her to our office for dental care or treatment, we must have written authorization. This authorization form is required for reasons pertaining to HIPAA, the Health Insurance Portability and Accountability Act, as well as the safety of your youngster. Your understanding and cooperation is greatly appreciated. Simply click the link below to download the form to your computer, print it, fill it out at your leisure, and send it with the person who brings your child to the appointment.