For your convenience, you can send us your Health History Form electronically. Because your privacy is critical, your form is sent using a secure server that is also HIPAA compliant.

Online Health History Form (print or submit online)

Please Note: Our Health History Form can be submitted in two ways: 1. Fill in the form online and submit it via our secure encrypted connection by clicking the "submit form" button at the bottom of the form. 2. Fill in the form online, print it and bring it to your appointment. If you choose to submit the form via our secure connection, we recommend printing the form before clicking the 'submit form' button (this provides a backup copy of your form).

Secure Internet Services

We also need you to fill out a Patient Acknowledgment and Consent Form. This form outlines our privacy practices about your patient information. You can print a copy of this form and bring it to your office with you for your appointment

Download/Print the Patient Acknowledgment & Consent Form

You may also have a referral form from your general dentist. Please bring that with you.

When you visit our office, please bring your insurance cards with you and be prepared to pay your co-pay at the time of service. If you’re unsure of your co-pay amount, please contact your insurance company before your appointment. We participate with Delta Dental and, while we don’t participate with other insurance companies, we’ll be happy to file a claim for you. To file an insurance claim for you we will need your social security number, so please be sure to include it when you fill out your Health History Form. If you don’t wish to provide us with your social security number, we do ask you for full payment at the time of service.