PATIENT FORMS
Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.
We ask that you review and complete our new patient forms carefully and bring them to your initial consultation.
Please do not hesitate to contact our office if you have any questions.
* In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
A CUSTODIAL PARENT OR COURT APPOINTED LEGAL GUARDIAN MUST ACCOMPANY PATIENTS UNDER THE AGE OF 18 OR DEPENDENT ADULTS FOR THE FULL DURATION OF THE SEDATION APPOINTMENT.
Thank you for your confidence in our office, we look forward to assisting you with all your dental needs.
We ask that you review and complete our new patient forms carefully and bring them to your initial consultation.
Please do not hesitate to contact our office if you have any questions.
* In order to view or print these forms you will need Adobe Acrobat Reader installed. Click here to download it.
A CUSTODIAL PARENT OR COURT APPOINTED LEGAL GUARDIAN MUST ACCOMPANY PATIENTS UNDER THE AGE OF 18 OR DEPENDENT ADULTS FOR THE FULL DURATION OF THE SEDATION APPOINTMENT.
NEW PATIENT QUESTIONNAIRE
This form must be completed prior to your/ your child's first appointment. It is very important that you complete all questions on the questionnaire to help Dr. Chow become familiar with your medical history. |
MEDICAL HISTORY FORM
The Medical History and Physical review form must be completed by your family physician prior to scheduling your treatment appointment. Please note that, in order to accurately complete the paperwork, your family physician may require that you schedule an appointment with him/her. |
INFORMED CONSENT FOR SEDATION
This form informs patients/guardians of the choices and risks involved with having treatment under sedation/general anesthesia. This information is not presented to make you apprehensive but to enable you to be better informed concerning your treatment. |
AUTHORIZATION TO RELEASE AND DISCUSS DENTAL INFORMATION
Our office requires written authorization to communicate with family members or friends on your behalf. This authorization does not entitle others to authorize treatment on your behalf. |
OFFICE POLICIES
In an effort to better serve you, we have outlined our office policies related to scheduling, fees for services and insurance claims. * Please note that some exceptions apply to NIHB and Healthy Smiles. |
PRE AND POST-OPERATORY INSTRUCTIONS
This form explains what to expect before/ during/ after your appointment. Please take the time to review this form carefully and keep it for your reference. |
FREQUENTLY ASKED QUESTIONS
Here you can easily find the answers to the most frequently asked questions. If you can't find your answers here, please contact us. |