Our Partners

Patient Forms

Thank you for choosing our office!

Our goal is to provide you with the best surgical care in a warm and caring environment. Listed below are the various forms that we will need to have filled out prior to treating you in our office.

Although Oral and Maxillofacial Surgeons primarily treat the area in and around your mouth, your mouth is a part of your entire body. Health problems that you may have or medication that you may be taking, could have an important interrelationship with the care that you will be receiving. Thank you for completing the forms below. Your answers are for our records and will be considered confidential. Please note that information provided by you is secure and will only be used in relation to your treatment in our office.

For more information regarding our policies and your privacy see our Notice of Privacy Practices.

 

Exclamation ExclamationPlease note that you will need to list ALL of your medications on the Health Information form. If you are taking blood thinning medications (i.e. Aspirin, Plavix, Coumadin) or a bisphosphonate medication (i.e. Fosamax, Actonel, Boniva), you will need to notify our office prior to your visit.  

 

New Patients

| Health Information | Patient Information |

 

Returning Patients
(Use for updates)

| Health Information | Patient Information |

 

We have several options for printing and sending the required forms:

You may print the forms and fill them out by hand using black ink,

You may fill out the forms on your computer and print them,

or

Complete each form and click on the “Submit by Email” button to send them directly to our office.

(When submitting, your email must come up with the form as an attachment.) 

Thank You!

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