Patient Forms

Please download, complete, and electronically sign (using Adobe Acrobat Reader) the forms you were requested to fill out prior to coming to our office.

If you are able to do so, please print your completed forms and bring them with you to your appointment.

If you do not have a printer, please save your completed forms on your device, bring the device with you to your appointment, and you will be able to print them at our office.

Please contact our office at 212.557.1300 or at [email protected] with any questions.

New Patient Medical History

This form is completed by a new patient to provide the practice with accurate medical and demographic information.

HIPAA Awareness

This form discusses the practice’s privacy policies.

Financial Policy

This form outlines responsibility for payment for services and the role of dental insurance in the transaction.

Credit Card Authorization

Completion of this form allows for remote credit card payment processing.

Medical History Form Update

This form is completed by a patient every two years in order to keep the patient’s medical and demographic information current.

Patient Guidelines

Please keep these COVID19 safety points in mind for your next appointment.