Patient Forms

Welcome to Dearfield Family Dentistry!

For your convenience, all New Patient Forms are available here for download. All New Patient Forms are in PDF and can be downloaded and filled offline. If possible please fill them prior to your appointment to minimize wait time.

New Patient Registration Form

Please download the New Patient Forms in PDF format.

Feel free to print out the form in order to fill it out!  Or, if it's more convenient, please email the completed form to info@dearfielddentistry.com.

 

Informed Consent Form

Please review the Informed Consent form. 

Feel free to print out the form in order to fill it out!  Or, if it's more convenient, please email the completed form to info@dearfielddentistry.com.

 

HIPAA Form

Please review the HIPAA form. 

Feel free to print out the form in order to fill it out!  Or, if it's more convenient, please email the completed form to info@dearfielddentistry.com.