Michael's Center For Dental Excellence
Patient Resources

Patient Forms

Save time at your appointment by downloading and completing your forms in advance. Print them out and bring them to your visit.

Save time at check-in
Complete at home
Print and bring with you

Download All Forms

Get all required patient forms in one convenient PDF package. Recommended for new patients to ensure you have everything needed for your first visit.

Download All Forms

New Patient Forms

Patient Information & Dental History

Complete patient demographics, contact information, and dental health questionnaire

Download

Patient Medical History

Comprehensive medical history including medications, allergies, and health conditions

Download

Insurance Forms

Insurance Information

Primary and secondary insurance coverage details for billing

Download

Financial Forms

Financial Policy

Payment terms, insurance filing procedures, and cancellation policy

Download

Legal Forms

Consent for Use and Disclosure of Health Information

HIPAA consent form for treatment, payment, and healthcare operations

Download

Notice of Privacy Practices

Detailed explanation of how your health information may be used and disclosed

Download

Release of Records

Authorization to transfer dental records, x-rays, and treatment notes

Download

How to Complete Your Forms

1

Download

Download the forms you need as PDF files to your computer or device.

2

Print & Complete

Print the forms and fill them out completely using blue or black ink.

3

Bring to Visit

Bring your completed forms with you to your appointment for faster check-in.

Need Help with Forms?

Our friendly staff is here to assist you. If you have questions about any forms, need help completing them, or prefer to fill them out at the office, please let us know.