Forms

New Patient Forms

For your convenience when visiting our office, please fill out the forms in the links below completely prior to your appointment with us.

English

New Patient Form
HIPAA Form
Financial Guidelines
Maryland Healthy Smiles Appointment Policy Form
Protected Health Information – PHI Form

Spanish

New Patient Form
HIPAA
Financial Guidelines
Maryland Healthy Smiles Appointment Policy Form
Protected Health Information – PHI Form (Spanish)

A parent or guardian is required to fill out the new patient/welcome forms in their entirety prior to the first visit.

Patient Forms

Please feel free to call the office at 301-989-8994 with any questions you may have.

English

Walk-Out Instructions
Sealant Consent
Extraction Consent
Various Dental Procedures
Health History Update
Silver Diamine Fluoride Treatment Consent
Frenectomy Informed Consent

Spanish

Walk-Out Instructions
Consentimiento de Tratamiento
Consentimiento de Sellador
Consentimiento Para El Tratamiento Con Fluoruro De Diamina De Platar