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Insurance & Forms

Common Patient Forms:

Patient Information Sheet (11 KB – PDF)
Patient Information Sheet (Spanish) (12 KB – PDF)
Medical History (17 KB – PDF)
Medical History (Spanish) (67 KB – PDF)
Consent to Proceed (12 KB – PDF)
Consent to Proceed (Spanish) (9 KB – PDF)
Federal Truth in Lending (12 KB – PDF)
Federal Truth in Lending (Spanish) (12 KB – PDF)

Other Forms:

English

Antibiotic Premedication – Heart (11 KB – PDF)
Antibiotic Premedication – Joints (14 KB – PDF)
Apicoectomies (15 KB – PDF)
Bone Graft – Sinus Lift (14 KB – PDF)
Complete Dentures (16 KB – PDF)
Composite Resin Fillings (17 KB – PDF)
Composites, Posterior (17 KB – PDF)
Cosmetic Treatment (24 KB – PDF)
Crown and Bridge Prosthetics (13 KB – PDF)
Crown and Bridge Removal (13 KB – PDF)
Immediate Dentures (18 KB – PDF)
Implants (13 KB – PDF)
New Premedicationn Guidelines (11 KB – PDF)
Occlusal Adjustment and Splint Therapy (15 KB – PDF)
Oral Sedation (16 KB – PDF)
Oral Surgery (22 KB – PDF)
Orthodontics (20 KB – PDF)
Pediatric Dentistry (20 KB – PDF)
Perio Procedures – Scaling (17 KB – PDF)
Perio Surgery (15 KB – PDF)
Posts (18 KB – PDF)
Pulpotomy (Perm. Teeth) (17 KB – PDF)
Pulpotomy Pulpectomy (19 KB – PDF)
Removal of Crowns and Bridges (13 KB – PDF)
Root Canal Retreatment (78 KB – PDF)
Root Canal Therapy (18 KB – PDF)
Sealants (15 KB – PDF)
Silver Amalgam Restorations (15 KB – PDF)
Temporomandibular Joint Therapy (TMJ) (15 KB – PDF)
 

Spanish

Bone Graft – Sinus Lift (Spanish) (16 KB – PDF)
Complete Partial Dentures (Spanish) (15 KB – PDF)
Composite Resin Fillings (Spanish) (14 KB – PDF)
Composite Resin – Posterior Filling (Spanish) (14 KB – PDF)
Cosmetic Treatment (Spanish) (18 KB – PDF)
Crown Bridge (Spanish) (20 KB – PDF)
Endodontics (Spanish) (16 KB – PDF)
Endo Retreatment (Spanish) (26 KB – PDF)
Immediate Dentures (Spanish) (16 KB – PDF)
Implants (Spanish) (33 KB – PDF)
Occlusal Adj – Splints (Spanish) (33 KB – PDF)
Occlusal Sealants (Spanish) (17 KB – PDF)
Oral Sedation (Spanish) (15 KB – PDF)
Oral Surgery (Spanish) (15 KB – PDF)
Pediatric Dentistry (Spanish) (13 KB – PDF)
Perio Procedures – Scaling (Spanish) (15 KB – PDF)
Pulpotomy (Perm. Teeth) (Spanish) (14 KB – PDF)
TMJ Treatment (Spanish) (59 KB – PDF)
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