Patient forms
Alas, no job is started until the paperwork is done.
And, that certainly is the case in health care, especially in the age of COVID-19. Please print out, complete, and sign these forms and consents so we can treat you when you come to our practice.
COVID-19 screening questionnaire
COVID-19 consent
Patient information includes option to provide your preference for text messaging (*see below for more information)
Patient health history
Endodontics office policies
Endodontics consent (wait to sign until you are in the office)
HIPAA consent
HIPAA notice
* SMS opt-in consent or phone numbers collected for SMS purposes will NOT be shared with third parties or affiliates for marketing purposes. We use it for contacting you about your appointments and treatment-related issues. Frequency depends on how often we need to contact you for these purposes. Carriers may charge fees for each message sent or received. These fees can vary based on the carrier's pricing structure and whether the message is sent domestically or internationally. To opt-out later, simply reply with STOP. For assistance, reply HELP. See our HIPAA notice (link above for our privacy policy and terms of service.