We are now offering the convenience of completing your patient forms online. Simply use the link below to access and submit your forms through our secure patient portal.

Visit Secure Patient Portal

To continue making your dental experience as pleasant as possible, we have conveniently provided our dental forms below. You can either fill them out through our secure patient portal or print the forms at home and bring them with you to your appointment.

New Patient: Child
Children’s Medical History
Child’s Informed Consent
HIPAA/ Generalized Patient Consent

For New Patients Who Are Still Nursing
Frenectomy

Sleep and Speech
Sleep and Speech Questionnaire

New Patient: Adult
Adult Medical History (seen at our Middleburg office)
HIPAA/ Generalized Patient Consent

Records
Transfer of Records

Treatment
Treatment Deposit