Patient Forms

To help make your visit to ProDent Care as smooth and efficient as possible, we provide patient forms that can be completed prior to your appointment. Preparing these forms in advance allows our team to better understand your dental and medical history and focus on your care when you arrive.

To ensure that you begin your appointment on time, please fill out the new patient forms below. 

 

Patient Packets

Existing Patient Packet

New Patient Packet

 

Individual Forms

Welcome Letter

Patient Registration Form

Insurance Information Form

Dental Questionnaire

Medical Questionnaire

Financial and Payment Policy

Assignment of Benefits

HIPAA Auth Acknowledgement & Consent Form

HIPAA Notices & Privacy Practices

Forms Downloads

• Welcome Form

• Patient Registration Form
• Dental Questionnaire
• Medical Questionnaire
• Financial & Payment Policy
• Assignment of Benefits
• HIPAA-Auth Acknowledge & Consent
• HIPAA-Notice of Privacy Practices

Combined

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