Forms

For New Patients

A couple sits on a couch, with their children standing behind them with their arms around their parent's shoulders.
New Patients Form

Before your first appointment, tell us about your medical and dental history.

A girl, around 10 years old, wears a reusable mask.
Covid-19 Screening

Before your appointment, complete this screening so we can determine if you have any symptoms that will prevent us from treating you.

A hand, covered in a blue medical glove, holds up three dental tools, two scraping devices and one mirror.
Doctor Referral Form

Referring a patient to us? Fill out this form.

A young woman lays in a dentist chair, smiling at the dentist.
Legal Referral Form

Does your client need treatment or evaluation for an accident?

Assessments & Questionnaires

Wondering if a dental treatment is right for you?

A woman on a orange background smiles and touches her face.
Cosmetic Assessment

Dreaming of a different smile? Fill out this form to see if cosmetic dentistry is right for you.

A woman touches her jaw and grimaces as if in pain.
TMJ Questionnaire

Feeling pain in your neck or jaw? It might be TMJ.

A woman holds her neck as if pain, the spot where she is holding is highlighted in red.
TMJ Questionnaire (Motor Vehicle Accident Patients)

Were you in a motor vehicle accident? Fill out this form to see if your accident resulted in TMJ.

A man and woman lay in bed, the man is asleep and snoring and the woman is holding her ears.
Sleep Disturbance Questionnaire

Are you losing sleep? It could be sleep apnea. Test your symptoms!