Patient Forms

 
580-355-1314

Please complete the forms below. Once the forms are completed the information is imported into our secure office network. We will have you sign the forms in our office. Thank you for allowing us to improve your oral health.

 

Patient Registration:  

Registration Form                                  

 

Financial/Office Policy:

                                                                  Financial Policy

 

Privacy Policy Acknowledgement: 

                                             Privacy Policy Acknowledgement

_________________________________________________________________________________________________________

Policy of Privacy Practices (Information only)_________________________________________________________________________________________________________ 

 

Please print the following questionnaire and complete it. You can then bring it with you to your appointment, fax it, or scan and email it to us.

Healthquestionnnaire.PDF 

 

 

Healthy Smiles

What does your smile say about you? Let us help you radiate confidence with a healthy smile.

Testimonials
ACCESSIBILITY