Forms

Now you may Download and Print your dental forms at your own home and bring them into the dental office before your first visit! It’s convenient, it’s less stressful, and it’s easy!

To download a form, simply click on the name of the form you wish to download.

Note: Forms are in Adobe PDF format and you will need an Adobe PDF Reader to view and print them.
Patient Registration

It’s important we have the most up to date information regarding your health history and billing information. All new patients are required to fill out a Patient Registration form, and we ask our current patients to update this information every two years, or sooner, if there have been any changes.

Notice of Privacy

The Notice of Privacy Practices explains how we use and protect your personal information.

Request a Copy of Your X-Ray

We require a signed authorization in order to release a copy of your x-rays. For adults, only the patient can authorize the release by signing the form. For children, only a parent or legal guardian may sign the form.

Send Us Your X-Rays

Have current x-rays at another office you want to send us? Print out this letter authorizing the release of your current x-rays to TriState Family Dental Centers. Don’t forget to sign it.

Treatment Consent - Under 18:

If you are not able to be present at your child’s dental appointment, we require you to have a Consent to Treatment form on file for your child. Sometimes it becomes necessary to send your child to the dentist with a relative or older sibling. Or, your older child may be able to drive himself to his appointments. This is not a problem with the consent to treatment form.