Coronavirus (COVID-19) Update

New Patient Forms

For your convenience when visiting our office, please print the forms in the links below, complete the information and bring it with you to your first visit.

New Patient Form
COVID-19: Patient Screening Form
Financial Guidelines – English
HIPA 1 – English
HIPA 2 – English
Formularios para Pacientes – Español
Directrices Financieras – Español

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

Maryland Healthy Smiles Appointment Policy Forms


To print the form you will need Adobe Acrobat Reader. If you do not have Adobe Acrobat, please click here to download it for free to your computer.


Patient Rewards

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Meet Our Doctors

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Buddies Not Bullies

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