Patient Forms
For Your Convenience…
Dentistry for Life provides the forms listed below for your convenience, as well as faster check-in when you arrive for your appointment. Please print and complete the forms, then bring them to your first visit. If you have trouble printing the forms, we’ll email or fax you copies.
Patient Information Packet
Click here to download all forms.
- Notice of Privacy Practices Acknowledgment: Your rights to privacy regarding your protected health information, and how this information may be used
- Patient Registration: Contact information
- Medical History: Medical health information
- Dental History: Information about your current and past dental health
- Financial Agreement and Cancellation Policy: Our payment policy, your payment options, insurance information, and cancellation requirements



