Patient resources
Patient Forms
Save time at your first visit. Download the forms below in English or Spanish, fill them out on your computer or by hand, sign them and bring them to your appointment.
¡Hablamos Español!Spanish-speaking front desk & dental assistantsHow to use these forms
- 1Download the forms you need. Each form can be filled out on a computer or printed and filled out by hand.
- 2Print and sign each form. Signatures must be handwritten.
- 3Bring the completed forms to your visit, or arrive early and fill them out at the office.
Please do not email completed forms
Completed forms contain your health information, and regular email is not a secure way to send it. Bring your forms with you or hand them to the front desk.
Forms to download
New Patient Registration
Your contact details, emergency contact, parent or guardian for minors, and dental insurance information.
Who needs it: All new patients
Medical and Dental History
Your health conditions, medications, allergies and dental history, so your dentist can treat you safely.
Who needs it: All new patients, updated each year
HIPAA Acknowledgment and Communication Preferences
Confirms you received our Notice of Privacy Practices and tells us how we may contact you and who we may talk to about your care.
Who needs it: All new patients
Authorization for Release of Dental Records
Lets you ask us to send your records or X-rays to you, another dentist, or anyone else you choose.
Who needs it: Only when you need records sent
Accommodation Request
Tell us ahead of time if you need a sign language interpreter, help with forms, large print, mobility planning or another accommodation.
Who needs it: Optional
Your rights and our notices
These notices explain how we protect your information and your rights as a patient.
- Notice of Privacy Practices (HIPAA)How we use and protect your health information, and your privacy rights.
- Nondiscrimination and AccessibilityHelp for patients with disabilities, website accessibility and how to file a grievance.
- Good Faith EstimateYour right to a written cost estimate if you are uninsured or not using insurance.
Need help with your forms?
Front desk staff and dental assistants at all four offices speak English and Spanish and can help you complete your forms. Call your office:
- Arlington(682) 284-1120
- Commerce(903) 246-4424
- Paris(903) 609-0567
- Grand Prairie(972) 262-5593