Please print and fill out these forms so we expedite your first vist.
- Office & Financial Policy Form
- Insurance Verification Form
- Dental Registration Form
- Smile Evaluation Form
- Dental History Form
- Health History Page 1 Form
- Health History Page 2 Form
- Acknowledgement of HIPAA Form
- Notice Of Privacy Form
Please print and fill out the following form if you need copies of your dental records.
Please print and fill out the following form if you would like to have In-house Dental Benefits Plan.
DO NOT email your personal information!
You may fax in your completed forms to the New Paltz office (845) 244-3083
- Or -
Bring in your completed forms with your insurance card of the time of appointment.