For your convenience, we offer downloadable patient forms that you can complete prior to your initial dental appointment
We welcome you as a new member of our dental family. To establish with our practice, we ask your assistance in getting to know you better so we can tailor your appointment to your individual needs.
Please view Financial Policy Acknowledgement for information about payments for your treatment. We offer our own In-Office Savings Plan to assist patients who do not have traditional dental insurance. Care Credit, a health care credit card, is also accepted.
Please print out and complete the following forms bringing them with you to your first appointment:
- Patient Information Registration
- Patient Health Record
- Dental Health Form
- New Patient Insurance Form
- Notice of Privacy Practices Acknowledgement of Receipt Form
- Financial Policy Acknowledgement
- Appointment No Show Policy
For more information on privacy issues, you may review our HIPAA Information Privacy Policies. If you have any questions concerning HIPAA, please contact Dr. Lessig here.
All documents will open using Adobe Acrobat Reader. If this is not installed on your computer, it may be downloaded by clicking on the acrobat logo.