Forms

Forms

filling out a form If you would like to complete your registration forms before you arrive, you may download them by clicking below. These forms are in Adobe Acrobat (PDF) format. If you do not have Acrobat Reader, get a free copy by clicking on the link below.

Please print the New Patient Forms, fill them out, and bring them with you for your appointment. Also, after reading the HIPAA Notice of Privacy Practices, print that page out, sign the bottom, and bring it in, too.

Notice: If you are connected to the Internet via dial-up connection, please be patient. Each form will take a few minutes to download.

Informed Consent Form (2,028 KB)

Medical Health History (2,995 KB)

Patient Account Registration (2,015 KB)

©Copyright 2004-2006 Dental WebSmith, Inc. and Karl A. Smith, D.D.S. ,L.L.C. All rights reserved. Disclaimer: The information provided within is intended to help you better understand dental conditions and procedures. It is not meant to serve as delivery of medical or dental care. If you have specific questions or concerns, contact your health care provider.