Patient Forms

Request Appointment

Before Your Visit

Please take a minute to print and fill out the patient information forms before your first appointment. Thank you!

  • COVID-19 Protocols PDF
  • New Patient Health History  PDF
  • Written Financial Policy  PDF
  • Notice of Privacy Practices  PDF
  • Patient Photo Consent and Release Form PDF

If you are coming in for a procedure, please fill out the applicable form(s) below.

  • Authorization for IV Conscious Sedation  JPG
  • Consent for Dental Implant Therapy  PDF
  • Consent for Intravenous Sedation  PDF
  • Consent for Root Canal  JPG
  • Moderate Sedation Consent Form  JPG
  • Walnut Ranch Consent for Extractions  PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

Call to make your appointment today!

(580) 226-1244