NEWSLETTER
SWITCH TO ADULT DENTISTRY
Patient Forms

SAVE TIME!  Complete the required dental and medical forms before your appointment!

 

NEW PATIENT FORMS (ALL FORMS ARE REQUIRED)
Print and complete each form.  Bring with you to your first appointment OR fax completed forms to the office where the patient is seen :

  1. Children's Forms Packet (pdf)  or  Children's Forms Packet (WORD)
  2. Dental Claim Form (pdf)

If you see a dentist at the Broomall/Havertown office, forms may be emailed to: Carly@childrens-dentistry.com.  We cannot accept emailed forms at any of our other offices.

 

Oral Surgery Only - Patient Forms

All forms are required for Oral Surgery / Wisdom Teeth Extraction.  Print each form and bring them with you to your first appointment OR fax completed forms to the office where the patient is seen : 

  1. Welcome Letter and Consent Form
  2. Patient Information Form
  3. Financial Responsibility Form
  4. Pre-Op Instructions